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Pegorin TC, Angelo M. Caring for children and families during the COVID-19 pandemic: innovations and changes experienced by nurses. Rev Esc Enferm USP 2024; 58:e20230355. [PMID: 38949511 PMCID: PMC11216165 DOI: 10.1590/1980-220x-reeusp-2023-0355en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/16/2024] [Indexed: 07/02/2024] Open
Abstract
OBJECTIVE To understand the experience of nurses working in pediatric units in the face of innovations and changes in the process of caring for children and families during the COVID-19 pandemic. Also, the objective is to understand the typical experience of nurses in this care. METHOD Qualitative research, which involved the participation of 16 nurses from pediatric units of a public teaching hospital. The data were analyzed according to the theoretical-methodological framework of Alfred Schütz's social phenomenology. RESULTS The participants' reports generated the categories: the challenge of experiencing changes amid fear, the team's adaptation to innovations and changes caused by the COVID-19 pandemic and the expectation for care and the work process. CONCLUSION The understanding of the nurses' experience highlighted changes, team adaptations and expectations for the care of children and families, which, although permeated by learning, were experienced by ethical dilemmas and moral suffering for these professionals.
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Affiliation(s)
- Talita Cristina Pegorin
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
| | - Margareth Angelo
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
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Wang LY, Tsai HM, Chen YW, Jhang JY, Wu PJ, Huang YT, Lee MY, Chen LC, Yu WP, Chiang MC. A preliminary study of the effectiveness of video visitation on depression and stress in mothers with preterm infants during the pandemic. Pediatr Neonatol 2024:S1875-9572(24)00092-5. [PMID: 38910078 DOI: 10.1016/j.pedneo.2023.12.011] [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: 04/18/2023] [Revised: 11/26/2023] [Accepted: 12/05/2023] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND AND PURPOSE Parents of preterm infants experience anxiety and stress in the neonatal intensive care unit (NICU). Visitation restrictions due to COVID-19 have increased maternal pressure and limited bonding opportunities. Little research exists in Taiwan on using video conferencing as a solution. This study investigates depression and stress levels in mothers of preterm infants and evaluates the effectiveness of video visitation during NICU restrictions. METHODS This study adopts a cross-sectional design and a qualitative survey. Mothers of premature infants were recruited and they participated in the study. Interventions for video visits were scheduled on the third day of admission to the NICU (T1) and during the second week of the study (T2). After each video visit, participants completed an online survey. The study's online survey used structured questionnaires including demographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Parental Stress Scale (PSS): Infant Hospitalization (IH). RESULTS A total of 51 mothers of preterm infants participated in the study. During the T1 and T2 periods, single mothers with lower educational levels and those aged below 30 experienced depression and high levels of stress. Lower birth weight and gestational age were associated with maternal depression. Video visitation intervention led to a significant decrease in depression scores (EPDS, T1: 11.3 ± 5.5 vs. T2: 10.1 ± 5.2, p = 0.039). Positive correlations were observed between EPDS and PSS: IH scores (p < 0 .005). CONCLUSION Video visitation intervention can reduce maternal depression in mothers with preterm infants. Since it is practical, video visitation may be applied even after the pandemic.
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Affiliation(s)
- Ling-Ying Wang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; MSc Program in Innovation for Smart Medicine, College of Management, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Min Tsai
- College of Nursing, Hungkuang University, Taichung, Taiwan
| | - Yi-Wen Chen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jing-Yi Jhang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Jhen Wu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Ting Huang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Ying Lee
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Li-Chen Chen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Wen-Pin Yu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Montoya-Williams D, Gualy S, Mazur M, Huber M, Peña MM, DeMauro SB, Duncan AF. Impact of COVID-19 on Infants followed after Discharge from the Neonatal Intensive Care Unit Using a Telemedicine Model. Am J Perinatol 2024; 41:e1075-e1083. [PMID: 36452972 PMCID: PMC10349908 DOI: 10.1055/a-1990-8571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) continues to have a profound impact on infant health care and health outcomes. In this study, we aimed to characterize the social impact of the first COVID-19 lockdown on families in a neonatal follow-up program (NFP). Given the ongoing increased use of telehealth across the medicine, we also evaluated for patient-level differences in virtual visit rates to identify patients at risk of follow-up challenges. STUDY DESIGN To assess the impact of virtual health care utilization, we conducted a retrospective cohort study to describe challenges associated with telemedicine use in this vulnerable patient population during our telemedicine epoch (March 13, 2020-July 31, 2020). We also looked for patient-level factors associated with attending NFP visits as scheduled. Finally, we summarized caregiver responses to a COVID-19 Obstacles Assessment Survey and assessed for racial disparities in these responses. RESULTS When comparing patients who completed their virtual visit to those who did not, we found no differences by infants' sex, birth weight, gestational age at birth, or caregiver self-reported race and ethnicity. However, infants whose visits did not occur were more often discharged with equipment or covered by public insurance. Nine percent of families reported food insecurity. CONCLUSION During the initial COVID-19 lockdown, families with infants discharged from a neonatal intensive care unit (NICU) faced significant obstacles caring for their infants and attending scheduled follow-up visits. Infants in families with lower socioeconomic status or with increased medical complexity faced increased challenges in attending virtual follow-up visits during this epoch. Given the ongoing reliance on telemedicine in health care and the need to better prepare for future epidemics/pandemics, this study offers critical information that can assist neonatal teams in bolstering transitions to home and creating stronger safety nets for their patients after discharge. KEY POINTS · Telemedicine works well for high-risk neonatal populations.. · Infant medical complexity may be a risk factor for challenges attending neonatal follow-up visits.. · NICUs should work to prevent food insecurity postdischarge..
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Affiliation(s)
- Diana Montoya-Williams
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | | | | | | | | | - Sara B. DeMauro
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
| | - Andrea F. Duncan
- Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine
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Sagaser A, Pilon B, Goeller A, Lemmon M, Craig AK. Parent Experience of Hypoxic-Ischemic Encephalopathy and Hypothermia: A Call for Trauma Informed Care. Am J Perinatol 2024; 41:586-593. [PMID: 35026852 PMCID: PMC9276837 DOI: 10.1055/a-1739-3388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Therapeutic hypothermia (TH) is the standard treatment for hypoxic-ischemic encephalopathy (HIE). We surveyed parents of infants treated with TH about their experiences of communication and parental involvement in the neonatal intensive care unit (NICU). STUDY DESIGN A 29-question anonymous survey was posted on a parent support (web site: https://www.hopeforhie.org ) and sent to members via e-mail. Responses from open-ended questions were analyzed using thematic analysis. RESULTS A total of 165 respondents completed the survey and 108 (66%) infants were treated with TH. 79 (48%) respondents were dissatisfied/neutral regarding the quality of communication in the NICU, whereas 127 (77%) were satisfied/greatly satisfied with the quality of parental involvement in the NICU. Six themes were identified as follows: (1) setting for communication: parents preferred face to face meetings with clinicians; (2) content and clarity of language: parents valued clear language (use of layman's terms) and being explicitly told the medical diagnosis of HIE; (3) immediate and longitudinal emotional support: parents required support from clinicians to process the trauma of the birth experience and hypothermia treatment; (4) clinician time and scheduling: parents valued the ability to join rounds and other major conversations about infant care; (5) valuing the parent role: parents desired being actively involved in rounds, care times, and decision-making; (6) physical presence and touch: parents valued being physically present and touching their baby; this presence was limited by the novel coronavirus disease 2019 (COVID-19)-related restrictions. CONCLUSION We highlight stakeholder views on parent involvement and parent-clinician communication in the NICU and note significant overlap with principles of trauma informed care: safety (physical and psychological), trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, and voice and choice. We propose that a greater understanding and implementation of these principles may allow the medical team to more effectively communicate with and involve parents in the care of infants with HIE in the NICU. KEY POINTS · Parents of infants with HIE experience trauma both from the birth and the hypothermia treatment.. · Transparent communication and encouraging parental involvement can ameliorate this trauma..
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Affiliation(s)
- Anna Sagaser
- Department of Pediatrics, Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME, USA
| | | | | | - Monica Lemmon
- Division of Pediatric Neurology and Developmental Medicine, Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexa K. Craig
- Department of Pediatrics, Division of Pediatric Neurology, Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME, USA
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Abreu RWFD, Lima CRG, Verdério BN, Santos MMD, Dos Santos AN, Brugnaro BH, Rocha NACF. Association between environmental factors during the COVID-19 pandemic and functioning of infants with biological risk in the first year of life: Cross-sectional exploratory study. Early Hum Dev 2024; 191:105987. [PMID: 38520911 DOI: 10.1016/j.earlhumdev.2024.105987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Child development can be influenced by family and environmental factors, which changed during the COVID-19 pandemic. Thus, it is important to explore how these factors are associated with the functioning of infants with biological risk in the first year of life. OBJECTIVE This study aimed to investigate associations between family factors, home opportunities, caregiver perception of environmental support and barriers at home and environmental factors during the COVID-19 pandemic and gross motor skills and home participation in infants with biological risk in the first year of life. METHODS Fifty-six infants aged two to 12 months (M = 5.80 months; ±2.44) and their mothers performed remote assessments of gross motor skills using the Alberta Infant Motor Scale (AIMS); participation and environment (phone call) by the Young Children's Participation and Environment Measure (YC-PEM); family factors (income, age and maternal education), home opportunities - The Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) and environmental factors during the COVID-19 pandemic (social distancing, emotional and financial factors and physiotherapy) (online forms). Regression models were constructed, considering gross motor skills and home participation as outcome variables, with a 5 % significance level. RESULTS We found that older maternal age (p = 0.001), more home opportunities (p = 0.043), and less rigorous social distancing (as opposed to total social distancing [p = 0.045]) were significantly associated with better gross motor skills; and higher maternal education (p = 0.050) was associated with more involvement in home activities. CONCLUSION Family factors, home opportunities and social distancing were differently associated with the gross motor skills and home participation of infants with biological risk in the first year of life.
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Affiliation(s)
- Raissa Wanderley Ferraz de Abreu
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Camila Resende Gâmbaro Lima
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Bruna Nayara Verdério
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Mariana Martins Dos Santos
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Adriana Neves Dos Santos
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil; Departament of Health Science, Federal University of Santa Catarina (UFSC), Araranguá, SC, Brazil.
| | - Beatriz Helena Brugnaro
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Nelci Adriana Cicuto Ferreira Rocha
- Infant Development Analysis Laboratory (LADI), Departament of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
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David J, Wambach CG, Kraemer M, Johnson TJ, Greene MM, Lee E, Patra K. Impact of the COVID-19 pandemic on early intervention utilization and need for referral after NICU discharge in VLBW infants. J Perinatol 2024; 44:40-45. [PMID: 37414845 DOI: 10.1038/s41372-023-01711-7] [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: 02/20/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To examine the impact of COVID-19 pandemic on early intervention (EI) services in VLBW infants. STUDY DESIGN 208 VLBW infants seen in NICU follow-up (FU) pre-COVID-19 were compared to 132 infants seen during COVID-19 at 4, 8 and 20 months corrected age (CA) in terms of enrollment in Child and Family Connections (CFC; intake agency for EI), EI therapies, need for CFC referral and Bayley scores. RESULTS Infants seen during COVID-19 at 4, 8 and 20 months CA were 3.4 (OR, 95% CI 1.64, 6.98), 4.0 (1.77, 8.95) and 4.8 (2.10, 11.08) times more likely to need CFC referral at FU based on severity of developmental delay. Infants followed during COVID-19 had significantly lower mean Bayley cognitive and language scores at 20 months CA. CONCLUSIONS VLBW infants seen during COVID-19 had significantly higher odds of needing EI and significantly lower cognitive and language scores at 20 months CA.
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Affiliation(s)
- Jieun David
- Department of Pediatrics, Rush University Children's Hospital, Rush University Medical Center, Chicago, IL, USA.
| | - Caroline G Wambach
- Department of Pediatrics, Rush University Children's Hospital, Rush University Medical Center, Chicago, IL, USA
| | - Megan Kraemer
- Department of Pediatrics, Rush University Children's Hospital, Rush University Medical Center, Chicago, IL, USA
| | - Tricia J Johnson
- Department of Health Systems Management, Rush University Medical Center, Chicago, IL, USA
| | - Michelle M Greene
- Department of Pediatrics, Rush University Children's Hospital, Rush University Medical Center, Chicago, IL, USA
| | - Esther Lee
- Department of Pediatrics, Rush University Children's Hospital, Rush University Medical Center, Chicago, IL, USA
| | - Kousiki Patra
- Department of Pediatrics, Rush University Children's Hospital, Rush University Medical Center, Chicago, IL, USA
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Eliason EL, Agostino J, Vivier P. Infant Health Care Disruptions by Race and Ethnicity, Income, and Insurance During the COVID-19 Pandemic. Acad Pediatr 2024; 24:105-110. [PMID: 37487800 DOI: 10.1016/j.acap.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Research has found disruptions in pediatric care during the COVID-19 pandemic, likely exacerbating existing disparities, which has not been explored among infants. This study evaluated how infant health care was disrupted during the COVID-19 pandemic overall and by race and ethnicity, income, and insurance type. METHODS This cross-sectional study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. Unadjusted, weighted proportions of outcomes were calculated overall and by race and ethnicity, income, and insurance. We estimated multivariable odds ratios for the association between infant care disruptions and race and ethnicity, income, and insurance. RESULTS Overall, among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. In adjusted analyses, we found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments were significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries. CONCLUSIONS Study findings suggest that the COVID-19 pandemic particularly affected infant health care for non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid, with important implications for addressing infant health inequities and improving health outcomes in the United States.
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Affiliation(s)
- Erica L Eliason
- Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI.
| | - Jasmine Agostino
- Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI
| | - Patrick Vivier
- Department of Public Health and Community Medicine (P Vivier), Tufts University School of Medicine, Boston, Mass
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MacNeil M, Campbell-Yeo M, McCulloch H, Hughes B, Dol J, Marriott N, Smith V, Alcock L. Parental Perspectives on Impact of Parental Presence Restrictions in the Neonatal Intensive Care Unit During the COVID-19 pandemic: A Cross-Sectional Study. J Perinat Neonatal Nurs 2023; 37:E17-E23. [PMID: 37773590 DOI: 10.1097/jpn.0000000000000714] [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: 10/01/2023]
Abstract
PURPOSE To describe parental experiences in the neonatal intensive care unit (NICU) during the COVID-19 restrictions. We explore what parents found most challenging, the impact these restrictions had on them and their infant, and how they coped. METHODS A cross-sectional online survey was completed by parents of infants who required care in a Canadian NICU during the early period of the COVID-19 pandemic. Data from 3 questions were coded using thematic analysis. RESULTS Participants ( n = 161) were primarily mothers (93%), with an average length of stay of 32.1 days. Three themes were identified from responses: (1) emotional and physical closeness of the parents to their infant; (2) physical and psychosocial well-being of the infant and parent; and (3) how parents coped, and strategies for moving forward. Parents reported that parental restriction policies adversely impacted their perceived physical and emotional closeness with their infant and their infant's physical and psychosocial well-being. Parents reported that being able to be present with their infant, having their partner able to be present with them, and effective communication helped them cope. CONCLUSION Despite the need for some restrictive policies to control the spread of the virus, the benefits and risks to the overall well-being of the parents and infants must be weighed.
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Affiliation(s)
- Morgan MacNeil
- School of Nursing, Faculty of Health (Mss MacNeil and Hughes and Dr Campbell-Yeo), and Departments of Pediatrics, Psychology and Neuroscience (Dr Campbell-Yeo), Dalhousie University, Halifax, Nova Scotia, Canada; IWK Health, Halifax, Nova Scotia, Canada (Mss MacNeil, McCulloch, Hughes, Marriott, Smith, and Alcock and Drs Campbell-Yeo and Dol); Department of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (Ms Hughes); and Mothering Transitions Research Lab, St Michael's Hospital, Toronto, Ontario, Canada (Dr Dol)
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Deindl P, Witting A, Dür M, Berger A, Klebermass-Schrehof K, Singer D, Giordano V, Fuiko R. Perceived stress of mothers and fathers on two NICUs before and during the SARS-CoV-2 pandemic. Sci Rep 2023; 13:14540. [PMID: 37666877 PMCID: PMC10477236 DOI: 10.1038/s41598-023-40836-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
Parents of very low birth weight (VLBW) infants in a neonatal intensive care unit experienced additional stress during the SARS-CoV-2 pandemic due to the related restrictions in hospital visiting policies. Our study aimed to compare parents' burdens before and during the pandemic. This survey included 121 parents of 76 VLBW infants in two European Level IV perinatal centers before and during the pandemic. We performed standardized parent questionnaires with mothers and fathers separately to evaluate their emotional stress and well-being. The pandemic worsened the emotional well-being of parents of VLBW infants, particularly of mothers. During the pandemic, mothers reported significantly higher state anxiety levels (48.9 vs. 42.9, p = 0.026) and hampered bonding with the child (6.3 vs. 5.2, 0 = 0.003) than before. In addition, mothers felt more personally restricted than fathers (6.1 vs. 5.2, p = 0.003). Fathers experienced lower levels of stress than mothers; they were equally burdened before and during the pandemic. Restrictions in visiting policies for families of VLBW infants during the SARS-CoV-2 pandemic have a significant negative impact on parental stress and should therefore be applied cautiously.
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Affiliation(s)
- Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Witting
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Mona Dür
- Duervation, Krems, Austria
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Dominique Singer
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Walker HR, Clarkson G, Alston H, Chan B. "All I Can Say Is Thank You": A Qualitative Study of Gratitude in the NICU Before and During COVID-19. J Perinat Neonatal Nurs 2023; 37:223-231. [PMID: 37494691 DOI: 10.1097/jpn.0000000000000679] [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: 07/28/2023]
Abstract
BACKGROUND COVID-19-associated visitor restrictions altered parents' involvement in their infant's care in the neonatal intensive care unit (NICU). PURPOSE The purpose of this article is to explore how restrictions affected parents' perceptions of experience in the NICU and to build a conceptual model of communication flow during times of crisis. METHODS This qualitative study was set in a level III 52-bed NICU. Using data from an open-ended survey question, a multitiered thematic analysis was used. RESULTS Four broad themes emerged: communication, gratitude, release, and containment of emotionality. These 4 themes interacted codependently and manifested differently as COVID-related visitor policies were put in place. Parents' characterization of communication also varied depending on the visitation policies. Before COVID, parents were more likely to reflect on communication. During COVID, parents expressed more gratitude, while containing negative emotions-sometimes using gratitude to soften the blow of bad feedback. IMPLICATIONS FOR PRACTICE AND RESEARCH Our theoretical model suggests that gratitude may serve as a form of "reciprocal care" to providers during a period of crisis and extreme stress. Use of high-quality communication between providers and parents in the NICU is necessary to understand parental concerns or negative experience.
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Affiliation(s)
- Heather R Walker
- Medical Group Analytics, University of Utah Health, Salt Lake City, Utah (Dr Walker); School of Nursing, College of Health, Idaho State University, Pocatello, Idaho (Dr Clarkson); College of Nursing, University of Utah, Salt Lake City, Utah (Dr Alston); and Neonatology Division, Department of Pediatrics, University of Utah, Salt Lake City, Utah (Dr Chan)
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Richter LL, Ku C, Mak MYY, Holsti L, Kieran E, Alonso-Prieto E, Ranger M. Experiences of Mothers of Preterm Infants in the Neonatal Intensive Care Unit During the COVID-19 Pandemic. Adv Neonatal Care 2023:00149525-990000000-00061. [PMID: 37036932 DOI: 10.1097/anc.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND The neonatal intensive care unit (NICU) stay following the birth of a preterm infant can be stressful and traumatic for families. During the COVID-19 pandemic, the NICU environment changed precipitously as infection control and visitor restriction measures were implemented. PURPOSE Our study aimed to examine the impact of the pandemic policies on the experiences of mothers of preterm infants during their stay in the NICU. METHODS Semistructured interviews were conducted with mothers of preterm infants hospitalized in a Canadian tertiary-level NICU. Informed by interpretive description methodology, interview content was transcribed and analyzed using a thematic analysis approach. The identified themes were validated, clarified, or refined using investigator triangulation. RESULTS Nine English-speaking mothers, aged 28 to 40 years, were interviewed. Four themes emerged from the analysis of their experiences: (1) disrupted family dynamic, support, and bonding; (2) physical and emotional isolation; (3) negative psychological impact compounded by added concerns, maternal role change, and survival mode mentality; and (4) positive aspects of the pandemic management measures. IMPLICATIONS FOR PRACTICE During the pandemic, the way that care was provided in the NICU changed. This study helps to explore how neonatal clinicians can foster individual and organizational resilience to keep patients and families at the center of care, even when the healthcare system is under intense stress. IMPLICATIONS FOR RESEARCH : Our results show that these changes heightened mothers' distress, but also had a modest positive impact. Further research about long-term consequences of pandemic policies on the mother and preterm infant after NICU discharge is warranted.
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Affiliation(s)
- Lindsay L Richter
- Department of Pediatrics (Ms Richter and Drs Holsti, Kieran, Alonso-Prieto, and Ranger), Emergency Medicine (Ms Mak), and Occupational Science and Occupational Therapy (Dr Holsti), University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada (Ms Richter and Drs Holsti, Kieran, Alonso-Prieto, and Ranger); and School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (Ms Ku and Dr Ranger)
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Kılıç ST, Taşgıt A. Sociodemographic factors affecting depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during the COVID-19 pandemic. JOURNAL OF NEONATAL NURSING : JNN 2023; 29:375-386. [PMID: 35965613 PMCID: PMC9359935 DOI: 10.1016/j.jnn.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
Purpose This study aimed to determine the sociodemographic factors affecting the depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during the COVID-19 pandemic. Design and Methods: This descriptive cross-sectional study was conducted between March and October 2021. The sample consisted of 93 parents. Data were collected using a descriptive questionnaire, the Depression Anxiety Stress Scale (DASS- 42), and Coping Style Scale (CSS). Results Participants had mean DASS "depression," "anxiety," and "stress" subscale scores of 13.69 ± 8.86, 12.11 ± 8.37, and 19.09 ± 9.24, respectively. They had mean CSS "self-confident," "optimistic," "helpless," "submissive coping," and "seeking of social support" subscale scores of 2.71 ± 0.65, 2.57 ± 0.59, 2.29 ± 0.62, 2.25 ± 0.49, and 2.38 ± 0.52, respectively. Fathers had lower mean CSS "helpless" and "submissive" subscale scores than mothers. Participants who were briefed about their babies' condition by nurses had lower mean CSS "helpless" and "submissive" subscale scores than others. Participants with higher education had lower mean CSS "helpless" and "submissive" subscale scores than others. Participants with spouses with bachelor's or higher degrees had a higher median CSS "optimistic" subscale score than those with literate spouses or spouses with primary school degrees. Participants who were worried about the "no visitors" policy had a lower median CSS "self-confident" subscale score than those who were not. Conclusions Parents who are not allowed to see their babies due to the "no visitors" policy during the COVID-19 pandemic experience more psychosocial problems. Though not a result of the present study, the "no visitors" policy seems to affect the mother-infant attachment adversely. Practice implications Healthcare professionals should brief parents about what a neonatal intensive care unit is like. They should also warn them that they may not be too happy about how their baby looks before seeing them. Therefore, they should use therapeutic communication techniques to talk to them and explain the situation in a way they can understand. Moreover, they should provide parents with psychological empowerment training programs to help them adopt active coping strategies to deal with challenges in times of crisis.
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Affiliation(s)
- Sevcan T. Kılıç
- Gerontology Department, ÇankırıKaratekin University, Çankırı, Turkey,Corresponding author. Gerontology Deparment, Çankırı Karatekin University, Çankırı, 18200, Turkey
| | - Asena Taşgıt
- Health Ministry of Turkish Republic Ankara City Hospital, Turkey
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Fuller MG, Lu T, Gray EE, Jocson MAL, Barger MK, Bennett M, Lee HC, Hintz SR. Rural Residence and Factors Associated with Attendance at the Second High-Risk Infant Follow-up Clinic Visit for Very Low Birth Weight Infants in California. Am J Perinatol 2023; 40:546-556. [PMID: 34044453 DOI: 10.1055/s-0041-1729889] [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: 10/21/2022]
Abstract
OBJECTIVE This study was aimed to determine factors associated with attendance at the second high-risk infant follow-up (HRIF) visit (V2) by 20 months of corrected age after a successful first visit (V1), and the impact of rural residence on attendance rates in a statewide population of very low birth weight (VLBW; <1,500 g) infants. STUDY DESIGN Data linked from the California Perinatal Quality of Care Collaborative (CPQCC) Neonatal Intensive Care Unit (NICU) database and CPQCC-California Children's Services (CCS) HRIF database. Multivariable logistic regression evaluated independent associations of sociodemographic, maternal, family, neonatal clinical, and individual HRIF program differences (factors) with successful V2 in VLBW infants born in 2010 to 2012. RESULTS Of 7,295 eligible VLBW infants, 75% (5,475) attended V2. Sociodemographic factors independently associated with nonattendance included maternal race of Black (adjusted odds ratio [aOR] = 0.61; 95% confidence interval [CI]: 0.5-0.75), public insurance (aOR = 0.79; 95% CI: 0.69-0.91), and rural residence (aOR = 0.74; 95% CI: 0.61-0.9). Factors identified at V1that were associated with V2 attendance included attending V1 within the recommended window (aOR = 2.34; 95% CI: 1.99-2.75) and early intervention enrollment (aOR = 1.39; 95% CI: 1.12-1.61). Neonatal factors associated with attendance included birth weight ≤750 g (aOR = 1.83; 95% CI: 1.48-2.5). There were significant program differences with risk-adjusted rates ranging from 43.7 to 99.7%. CONCLUSION Sociodemographic disparities and HRIF program factors are associated with decreased attendance at V2 among VLBW infants. These findings highlight opportunities for quality and process improvement interventions starting in the NICU and continuing through transition to home and community to assure participation in HRIF. KEY POINTS · Only 75% of VLBW infants attended the second HRIF visit.. · Those less likely to attend were Black or had rural residence.. · Infants in early intervention or attending first visit within recommended ages were more likely to attend..
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Affiliation(s)
- Martha G Fuller
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, California
| | - Tianyao Lu
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality of Care Collaborative, Stanford, California
| | - Erika E Gray
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality of Care Collaborative, Stanford, California
| | - Maria A L Jocson
- Department of Health Care Services, California Children's Services, Integrated Systems of Care, Sacramento, California
| | - Mary K Barger
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, California
| | - Mihoko Bennett
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality of Care Collaborative, Stanford, California
| | - Henry C Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality of Care Collaborative, Stanford, California
| | - Susan R Hintz
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality of Care Collaborative, Stanford, California
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Psychosocial Difficulties Experienced By Parents Of Babies Treated In A Neonatal Intensive Care Unit During The Coronavirus Pandemic. Arch Psychiatr Nurs 2022; 41:295-299. [PMID: 36428063 PMCID: PMC9444850 DOI: 10.1016/j.apnu.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
AIM This study had two objectives: (1) to investigate the psychosocial difficulties experienced by parents of babies treated in a neonatal intensive care unit during the coronavirus pandemic and (2) to determine parent-infant attachment. MATERIALS AND METHODS This study adopted phenomenology, a qualitative research design in order to answer the research questions design. The sample consisted of 20 parents of babies treated in the neonatal intensive care unit (NICU) of a City Hospital in Turkey between July and August 2021. Participation was voluntary. Data were collected using a sociodemographic characteristics questionnaire and a semi-structured qualitative interview form. Each participant was interviewed face to face. Each interview was recorded and transcribed. The data were analyzed using content analysis. RESULTS Participants had a mean age of 32.2 ± 3.61 years and at least secondary school degrees. Babies were admitted to the NICU for congenital anomalies (n = 3) or preterm birth (n = 7). Participants experienced anxiety, worry, and loneliness and produced less milk because they could not see and touch their babies. Their greatest source of support was their spouses. CONCLUSION Parents of babies treated in the NICU during the COVID-19 pandemic experience anxiety, sadness, unhappiness, and loneliness. The preventive measures against the pandemic affect parents psychosocially. Healthcare professionals should plan and implement care practices and establish effective communication with parents to identify their physiological, psychological, and social needs and help them produce breastmilk and bond with their babies.
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Griffith T, Singh A, Naber M, Hummel P, Bartholomew C, Amin S, White-Traut R, Garfield L. Scoping review of interventions to support families with preterm infants post-NICU discharge. J Pediatr Nurs 2022; 67:e135-e149. [PMID: 36041959 PMCID: PMC9729411 DOI: 10.1016/j.pedn.2022.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND A successful transition from the NICU to home is fundamental for the long-term health and well-being of preterm infants. Post-NICU discharge, parents may experience a lack of support and resources during the transition to home. The purpose of this scoping review was to identify post-NICU discharge interventions that may reduce parental stress and provide support to families with preterm infants. METHOD Systematic searches of databases, i.e., PubMed, Web of Science, and CINAHL. Inclusion criteria were data-based articles: 1) published in English between 2011 and 2021, 2) published in peer-reviewed journals, (3) focused on families with preterm infants, and (4) focused on interventions to reduce parental stress and provide support to families with preterm infants post-NICU discharge. RESULTS 26 articles were included and synthesized. We identified the following face-to-face and remote communication interventions: in-person home visits, phone/video calls, text messages, periodic email questionnaires, mobile/website apps, and online social networking sites. DISCUSSION Families may highly benefit from a comprehensive family-focused post-NICU discharge follow-up intervention that includes face-to-face and remote communication and support. Post-NICU discharge interventions are imperative to provide education related to infant care and health, increase parental confidence and competency, increase parent-infant relationship, promote emotional and social support, reduce unplanned hospital visits, parental stress, and maternal post-partum depression.
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Affiliation(s)
- Thao Griffith
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA.
| | - Anamika Singh
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Margaret Naber
- Division of Neonatology, Loyola University Medical Center, Maywood, IL, USA
| | - Patricia Hummel
- Division of Neonatology, Loyola University Medical Center, Maywood, IL, USA
| | | | - Sachin Amin
- Division of Neonatology, Loyola University Medical Center, Maywood, IL, USA
| | - Rosemary White-Traut
- Nursing Research, Children's Wisconsin, Milwaukee, WI, United States of America; Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Lindsey Garfield
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
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16
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Raho L, Bucci S, Bevilacqua F, Grimaldi T, Dotta A, Bagolan P, Aite L. The NICU during COVID-19 Pandemic: Impact on Maternal Pediatric Medical Traumatic Stress (PMTS). Am J Perinatol 2022; 39:1478-1483. [PMID: 34883523 DOI: 10.1055/a-1717-4021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this paper was to assess how hospital and outpatient clinic policies changes due to the coronavirus disease 2019 (COVID-19) pandemic impact pediatric medical traumatic stress (PMTS) symptoms in mothers of newborns admitted in a neonatal intensive care unit (NICU). STUDY DESIGN Observational case-control study included the comparison between mothers of infants admitted in the NICU at birth during the COVID-19 pandemic and mothers of infants admitted in the NICU before the COVID-19 pandemic. The control group was selected matching 1:1 with the study group for the following infants' clinical variables: gender, type of pathology, gestational age, weight at birth, day of recovery, ventilator time days, and associated malformations. The Italian version of the Impact of Event Scale-Revised (IES-R) was used as a measure of PMTS. RESULT Mothers of the study group (50) scored significantly higher than mothers of the control group on three of four scales of IES-R ("IES-R total": F = 6.70; p = 0.011; IES-R subscale "intrusion": F = 7.45; p = 0.008; IES-R subscale "avoidance": F = 8.15; p = 0.005). A significantly higher number of mothers in the study group scored above the IES-R total clinical cut-off compared with mothers of control group (72 vs. 48%; Chi2 = 6.00; p = 0.012). CONCLUSION The COVID-19 pandemic acted as superimposed stress in mothers of newborns admitted in the NICU at birth determining high levels of PMTS. Clinicians and researchers should identify and implement novel strategies to provide family-centered care during the COVID-19 pandemic and beyond. KEY POINTS · COVID-19 acted as superimposed stress on NICU population.. · PMTS in mothers got significantly worse during the COVID-19 pandemic.. · Alert on long-term consequences on child development..
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Affiliation(s)
- Laura Raho
- Medical and Surgical Department of the Foetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvia Bucci
- Unit of Clinical Psychology, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Bevilacqua
- Unit of Clinical Psychology, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Teresa Grimaldi
- Unit of Clinical Psychology, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Dotta
- Medical and Surgical Department of the Foetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pietro Bagolan
- Medical and Surgical Department of the Foetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lucia Aite
- Unit of Clinical Psychology, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Coşkun Şimşek D, Günay U, Özarslan S. The impact of the COVID-19 pandemic on nursing care and nurses' work in a neonatal intensive care unit. J Pediatr Nurs 2022; 66:44-48. [PMID: 35635999 PMCID: PMC9135281 DOI: 10.1016/j.pedn.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/18/2022] [Accepted: 05/11/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE This study was conducted to determine the effects of the COVID-19 pandemic process on nursing care and nurses' work in neonatal intensive care units. DESIGN AND METHODS The study was conducted using a qualitative method. The data were collected by voice recording with a one-on-one in-depth interview technique, and a semi-structured question form was used in the interviews. The data obtained from voice recordings were evaluated using the qualitative content analysis method. RESULTS The main themes and subthemes of the study were as follows: (1) decrease in physical contact with newborns due to fear of transmitting Covid-19 (decrease in physical contact between neonatal nurses and newborns, decrease in physical contact between mothers and newborns, decrease in physical contact between fathers and newborns), (2) communication problems between healthcare professionals and parents (3) changes in the working conditions for neonatal nurses (increase in the frequency and duration of work intense working speed, exhaustion and decreased motivation due to use of protective equipment). CONCLUSION The COVID-19 pandemic process led to a decrease in nurses' and parents' touching newborns, nurses' experiencing problems with parents due to measures taken, heavier working conditions and a decrease in motivation for nurses. PRACTICE IMPLICATIONS This study will inform future research to be directed to nursing care and the work of nursing who work on the front line in the COVID-19 pandemic process.
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Affiliation(s)
- Didem Coşkun Şimşek
- Assistant Professor, Fırat University, Faculty of Health Sciences, Department of Pediatric Nursing, Elazığ, Turkey.
| | - Ulviye Günay
- Associate Professor, Inonu University, Faculty of Nursing, Department of Pediatric Nursing, Campus 44280 Malatya, Turkey.
| | - Sümeyye Özarslan
- Specialist Nurse, Inonu University, Health Sciences Institute, Malatya, Turkey
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18
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Lakshmanan A, Rogers EE, Lu T, Gray E, Vernon L, Briscoe H, Profit J, Jocson MAL, Hintz SR. Disparities and Early Engagement Associated with the 18- to 36-Month High-Risk Infant Follow-Up Visit among Very Low Birthweight Infants in California. J Pediatr 2022; 248:30-38.e3. [PMID: 35597303 DOI: 10.1016/j.jpeds.2022.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/14/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine follow-up rates for the high-risk infant follow-up (HRIF) visit at 18-36 months among infants with very low birthweights and identify factors associated with completion. STUDY DESIGN We completed a retrospective cohort study using linked California Perinatal Quality of Care Collaborative neonatal intensive care unit, California Perinatal Quality of Care Collaborative California Children's Services HRIF, and Vital Statistics Birth Cohort databases. We identified maternal, sociodemographic, neonatal, clinical, and HRIF program level factors associated with the 18- to 36-month follow-up using multivariable Poisson regression. RESULTS From 2010 to 2015, among 19 284 infants with very low birthweight expected to attend at least 1 visit at 18-36 months, 10 249 (53%) attended. On multivariable analysis, factors independently associated with attendance at an 18- to 36-month visit included estimated gestational age (relative risk [RR], 1.21; 95% CI, 1.15-1.26; <26 weeks vs ≥31 weeks), maternal education (RR, 1.09; 95% CI, 1.06-1.12; college degree or more vs high school), distance from clinic (RR, 0.92; 95% CI, 0.89-0.97; fourth quartile vs first quartile), and Black non-Hispanic race vs White race (RR, 0.88; 95% CI, 0.84-0.92). However, completion of an initial HRIF visit within the first 12 months was the factor most strongly associated with completion of an 18- to 36-month visit (RR, 6.47; 95% CI, 5.91-7.08). CONCLUSIONS In a California very low birthweight cohort, maternal education, race, and distance from the clinic were associated with sustained HRIF participation, but attendance at a visit by 12 months was the most significantly associated factor. These findings highlight the importance of early engagement with all families to ensure equitable follow-through for children born preterm.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.
| | | | - Tianyao Lu
- California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Erika Gray
- California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Lelis Vernon
- Florida Perinatal Quality Collaborative (PQC), Tampa, FL; Stanford University School of Medicine Department of Pediatrics, Division of Neonatal and Developmental Medicine, Palo Alto, CA
| | | | - Jochen Profit
- California Perinatal Quality Care Collaborative, Palo Alto, CA; Florida Perinatal Quality Collaborative (PQC), Tampa, FL
| | - Maria A L Jocson
- California Department of Health Care Services, California Children's Services, Sacramento, CA
| | - Susan R Hintz
- California Perinatal Quality Care Collaborative, Palo Alto, CA; Florida Perinatal Quality Collaborative (PQC), Tampa, FL
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Sabapathy T, Bansal R, Bojorquez L, Salley B, Gianakon JG, Gelineau-Morel R, Nyp SS. Missed Opportunities and the Impact of the Pandemic. J Dev Behav Pediatr 2022; 43:176-179. [PMID: 35085180 PMCID: PMC9203908 DOI: 10.1097/dbp.0000000000001065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CASE Benjamin is a 9-month-old, former 36-week gestation infant who presented to the high-risk infant follow-up clinic with parental concern for developmental regression. His mother reported that Benjamin seemed to be developing typically, but over the past 2 months, he has lost the ability to visually track objects, is not as engaged with her as he once was, and now only rarely makes babbling sounds. His mother also reported episodes of intermittent "bursts" of stiffening of his extremities and brief staring spells. Benjamin's mother described him as a "good, quiet baby." She commented that he used to laugh and cry more frequently but has recently been "very peaceful and calm." Benjamin's mother recently relayed her concerns for developmental regression to his pediatrician during an audio-only telehealth visit. Benjamin was referred to a pediatric neurologist, and the consultation visit is pending.His mother is a 28-year-old single parent whose pregnancy was complicated by pre-eclampsia, gestational diabetes, and anxiety. Benjamin required admission to the neonatal intensive care unit because of initial feeding difficulties. After 1 week, Benjamin was discharged to home and was referred for early intervention services. Owing to the pandemic, there were delays with initiating intervention, but bimonthly virtual interaction with a representative from the infant development program was eventually provided.Benjamin's mother expressed significant concerns regarding the potential of exposing him to a pandemic-related illness because of bringing her son to in-person medical visits. In fact, because of her concerns, she attended only virtual well-child pediatric visits over the past 6 months. A thorough social history revealed that she is a former dance studio instructor. The studio closed and she lost her primary source of income because of the pandemic. As a result, she decided to not send Benjamin to child care and maintained isolation from extended family members.On physical examination, pertinent findings included poor truncal tone, lack of orientation toward sounds, and limited eye contact. The Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was administered, and the results indicated severe delays across all developmental areas, consistent with a diagnosis of global developmental delay.Benjamin's clinical presentation to the HRIF clinic and a history of developmental regression and intermittent body movements raised concerns for infantile spasms. He was transferred to the emergency department for evaluation and consideration for admission to the neurology service. An electroencephalogram confirmed epileptiform abnormalities consistent with infantile spasms, and he was immediately started on treatment.Impacts of the pandemic on the medical care of vulnerable/at-risk pediatric patients have included delayed receipt of early intervention services, parental fear regarding potential exposure to pandemic-related illness while seeking preventative care, increased use of virtual visit platforms for medical care and developmental intervention services, etc. What factors should be considered when providing support for these vulnerable/at-risk patients?
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Affiliation(s)
- Thusa Sabapathy
- The Center for Autism & Neurodevelopmental Disorders, University of California Irvine, Santa Ana, CA
| | | | | | - Brenda Salley
- Department of Pediatrics, University of Kansas Medical Center, Children's Mercy Kansas City, University of Kansas School of Medicine, Kansas City, KS
| | | | - Rose Gelineau-Morel
- Pediatric Neurology, University of Missouri-Kansas City, Division of Neurology, Children's Mercy Kansas City, Kansas City, MO
| | - Sarah S Nyp
- The Center for Autism & Neurodevelopmental Disorders, University of California Irvine, Santa Ana, CA
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20
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Vetcho S, Cooke M, Petsky H, Saito A, Ullman AJ. Family-centred care change during COVID-19. Nurs Crit Care 2022; 27:460-468. [PMID: 35234320 PMCID: PMC9115396 DOI: 10.1111/nicc.12766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Family-centred care (FCC) is an approach to promote family and health care provider partnership. This has been incorporated into neonatal intensive care units (NICUs) worldwide. However, FCC in low resource health settings, such as Thailand, is challenging and further impacted by coronavirus disease 2019 (COVID-19). AIMS To evaluate FCC innovations to improve respect, collaboration and support in a Thai NICU. STUDY DESIGN A quasi-experimental study was conducted in an NICU in southern Thailand. Pre-implementation was prior to COVID-19, and parental and staff perceptions of FCC were measured via Perceptions of Family Centred Care-Parent (PFCC-P) and -Staff (PFCC-S) survey. The FCC innovations were developed by stakeholders based on the COVID-19 restrictions, pre-survey results, parents' and clinicians' interviews and integrative review, then implemented via a flowchart. Post-implementation evaluation was via repeated surveys. Comparisons were made pre-and post-implementation, with Mann-Whitney U-test statistics for parents and Wilcoxon's Rank Sum for staff. RESULTS A total of 185 (85 pre; 100 post) parents and 20 (pre and post; paired group) health care professionals participated. Because of COVID-19, many planned interventions were unfeasible, however, other innovations achieved (e.g., structured telephone updates, information booklet revision). There was an increase in parents' perception of respect ([median] 2.50-3.50), collaboration (2.33-3.33) and support (2.60-3.60) domains and overall (2.50-3.43; p < .001; 95% CI: 2.93-3.11). Interdisciplinary professionals' perception of FCC did not significantly change pre-and post-implementation/COVID-19 pandemic for respect (3.00-2.92), collaboration (3.22-3.33), support (3.20-3.20) and overall (3.15-3.20; 95% CI: 3.10-3.25). CONCLUSION Despite the challenges of COVID-19 restricting NICU access, the provision of FCC was maintained and even improved. RELEVANCE TO CLINICAL PRACTICE Further research is necessary to develop FCC practice innovations associated with communication, across diverse health care systems and resources.
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Affiliation(s)
- Siriporn Vetcho
- School of Nursing and Midwifery, Griffith University, Brisbane.,Menzies Health Institute Queensland, Griffith University, Brisbane.,Faculty of Nursing, Prince of Songkla University, Songkhla
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane
| | - Helen Petsky
- School of Nursing and Midwifery, Griffith University, Brisbane.,Menzies Health Institute Queensland, Griffith University, Brisbane
| | - Amornrat Saito
- School of Nursing and Midwifery, Griffith University, Brisbane.,Menzies Health Institute Queensland, Griffith University, Brisbane
| | - Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Brisbane.,Children's Health Queensland and Health Service, Centre of Children's Health Research, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Australia
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21
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Lakshmanan A, Sunshine I, Escobar CM, Kipke M, Vanderbilt D, Friedlich PS, Mirzaian CB. Connecting to Early Intervention Services After Neonatal Intensive Care Unit Discharge in a Medicaid Sample. Acad Pediatr 2022; 22:253-262. [PMID: 34757023 PMCID: PMC8901461 DOI: 10.1016/j.acap.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe caregiver perspectives regarding connecting to early intervention (EI) services after neonatal intensive care unit discharge in a Medicaid sample. METHODS Open-ended semistructured interviews and focus groups were conducted with English- or Spanish-speaking families enrolled in Medicaid in an urban high-risk infant follow-up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis. RESULTS Thirty-two participants completed the study. The infant's median (interquartile range) birth weight was 1365 (969, 2800) grams; 50% were Hispanic; 31% reported living in a neighborhood with fourth quartile economic hardship. Eighty-one percent were classified as having chronic complex disease per the Pediatric Medical Complexity Algorithm and 63% had a diagnosis of developmental delay. A conceptual model was constructed and the analysis revealed major themes describing families' challenges and ideas to facilitate connection to EI. We identified subthemes related to the person in environment: health care environment/support and socio-economic resources, parent perspectives and built environment; provider level factors such as appointment scheduling, staff limitations, and parent suggestions to improve health care and service navigation, which included improved information sharing, the importance of patient advocates, video resources, early referrals to EI facilitated by the discharging hospital and system workarounds. CONCLUSIONS The results from this study may provide a granular roadmap for providers to help facilitate referrals to EI services. We identified several ideas such as using advocates and providing transitional resources, including online media, that might improve the connection to EI services.
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Affiliation(s)
- Ashwini Lakshmanan
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California (A Lakshmanam), Los Angeles, Calif; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (A Lakshmanam), Los Angeles, Calif.
| | - Isabel Sunshine
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Cindy M Escobar
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Michele Kipke
- Division of Research on Children, Youth and Families, Children's Hospital, Keck School of Medicine, University of Southern California (M Kipke), Los Angeles, Calif; Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (M Kipke), Los Angeles, Calif
| | - Douglas Vanderbilt
- Section of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (D Vanderbilt), Los Angeles, Calif
| | - Philippe S Friedlich
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (CB Mirzaian), Los Angeles, Calif
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22
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Lakshmanan A, Song AY, Belfort MB, Yieh L, Dukhovny D, Friedlich PS, Gong CL. The financial burden experienced by families of preterm infants after NICU discharge. J Perinatol 2022; 42:223-230. [PMID: 34561556 PMCID: PMC8460846 DOI: 10.1038/s41372-021-01213-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Describe the financial burden and worry that families of preterm infants experience after discharge from the neonatal intensive care unit (NICU). METHODS We surveyed 365 parents of preterm infants in a cross-sectional study regarding socio-demographics, supplemental security income (SSI), and financial worry. We completed a multivariable logistic regression model to examine the adjusted association of financial worry with modifiable factors. RESULTS We found that 53% of participants worried about healthcare costs after NICU discharge. After adjusting for socio-demographic and infant characteristics, we identified that, aOR (95% CI), out-of-pocket costs from the NICU index hospitalization, 3.51 (1.7, 7.26) and durable medical equipment use, 2.41 (1.11, 5.23) was associated with increased financial worry while enrollment in SSI, 0.38 (0.19, 0.76) was associated with decreased financial worry. CONCLUSIONS We identified factors that could contribute to financial burden after NICU discharge that may advise future work to target financial support systems.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, 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.
| | - Ashley Y. Song
- grid.21107.350000 0001 2171 9311Department of Preventive Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Mandy B. Belfort
- grid.62560.370000 0004 0378 8294Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Leah Yieh
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA USA
| | - Dmitry Dukhovny
- grid.5288.70000 0000 9758 5690Division of Neonatology, Department of Pediatrics, Oregon Health Sciences University, Portland, OR USA
| | - Philippe S. Friedlich
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Cynthia L. Gong
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA USA
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23
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Scala M, Marchman VA, Brignoni-Pérez E, Morales MC, Dubner SE, Travis KE. Impact of the COVID-19 pandemic on developmental care practices for infants born preterm. Early Hum Dev 2021; 163:105483. [PMID: 34649193 PMCID: PMC8489845 DOI: 10.1016/j.earlhumdev.2021.105483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/09/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm. METHODS We analyzed electronic medical record data from 129 infants born at less than 32 weeks gestational age (GA) cared for in the Lucile Packard Children's Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to Nov 30, 2020, n = 67) and the analogous period in 2019 (n = 62). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for covariates. RESULTS Families of infants visited the hospital at nearly half of the rate during 2020 as during 2019 (p = 0.001). Infants experienced developmental care less frequently in 2020 vs. 2019 (3.0 vs. 4.3 activities per day; p = 0.001), resulting in fewer minutes per day (77.5 vs. 130.0; p = 0.001). In 2020, developmental care activities were 5 min shorter, on average, than in 2019, p = 0.001. Similar reductions occurred in both family- and staff-delivered developmental care. Follow-up analyses indicated that effects persisted and even worsened as the pandemic continued through fall 2020, despite relaxation of hospital visitation policies. CONCLUSIONS The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.
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Affiliation(s)
- Melissa Scala
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA.
| | - Virginia A Marchman
- Department of Psychology, Stanford University, Stanford, CA, USA; Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
| | - Edith Brignoni-Pérez
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Maya Chan Morales
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
| | - Sarah E Dubner
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
| | - Katherine E Travis
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, USA
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24
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Williams TS, Deotto A, Roberts SD, Ford MK, Désiré N, Cunningham S. COVID-19 mental health impact among children with early brain injury and associated conditions. Child Neuropsychol 2021; 28:627-648. [PMID: 34779687 DOI: 10.1080/09297049.2021.1998407] [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: 10/19/2022]
Abstract
This study describes the impact of COVID-19 among a clinical research sample of children with early brain injury and associated conditions. Between March 2020 and March 2021, 64 children and their parents participated. Children ranged in age between 3 and 14 years (M = 6 years, 3 months; SD = 2 years, 4 months) with a range of diagnoses (i.e., neonatal stroke, hypoxic ischemic encephalopathy (HIE), congenital heart disease (CHD) and preterm birth (<32 weeks)). The abbreviated CoRonavIrus Health Impact Survey (CRISIS) was completed by parents as part of their child's routine intake for neuropsychological services. Questions included COVID-19 specific ratings of child mental health impact, child, and parent stressors, with open-ended questions regarding negative and positive COVID-19 related changes. Over 40% of parents described moderate to extreme influence of COVID-19 on their child's mental health. Common child stressors reported included restrictions on leaving the home and social isolation. Among parents, the most common stress reported was caring for their child's education and daily activities. Children's mental health impact was associated with social isolation, parent mental health, COVID-19 economic concern, and number of siblings in the home. Child's age, sex, brain injury severity, or intellectual functioning were not associated with reported COVID-19 mental health impact. Some COVID-19 positives were identified, namely increased quality family time. Findings reflect the significant pandemic mental health impact among neurologically at-risk children and their families. Implications to future clinical needs and considerations for neuropsychological practice are discussed.
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Affiliation(s)
- Tricia S Williams
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Psychiatry, The University of Toronto, Toronto, Ontario, Canada
| | - Angela Deotto
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
| | - Samantha D Roberts
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
| | - Meghan K Ford
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Naddley Désiré
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Cunningham
- Department of Psychology, Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
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25
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Abstract
While medical advancements have led to improved survival of extremely premature infants, children remain at risk for brain injury and neurodevelopmental impairment. Brain imaging can offer insight into an infant's acute and long-term outcome; however, counseling parents about the results and implications of brain imaging remains challenging. The purpose of this article is to review the current literature and describe the challenges associated with counseling families of premature infants on neuroimaging findings. We propose a framework to guide clinicians in counseling parents about brain imaging results, informed by best practices in other disciplines: (FIGURE): 1) Formulate a plan 2) Identify parental needs and values 3) Give information 4) Acknowledge Uncertainty 5) Recognize and Respond to emotions 6) Discuss Expectations and Establish follow-up.
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Affiliation(s)
- Sarah M Bernstein
- Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | | | - Monica E Lemmon
- Departments of Pediatrics and Population Health Sciences, Duke University Medical Center, Duke-Margolis Center for Health Policy, DUMC 3936, Durham, NC 27710, United States.
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26
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Position Statement of the International Network for Child and Family Centered Care: Child and Family Centred Care during the COVID19 Pandemic. J Pediatr Nurs 2021; 61:140-143. [PMID: 34052501 PMCID: PMC8135188 DOI: 10.1016/j.pedn.2021.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/22/2022]
Abstract
It is the position of the International Network for Child and Family Centered Care (INCFCC) that COVID19 restrictions pose tremendous challenges for the health care team in their efforts to provide child and family centered care (CFCC). COVID-19 restrictions impact on the family's right to be presernt with their ill child and to contribute to the caring process. A limited number of articles have discussed challenges about the successful delivery of CFCC during the COVID-19 pandemic. Based on current literature, the INCFCC stresses the need for continuous facilitation implementation of child and family centred care as, it is essential for children's physical and psychological wellbeing. Furthermore we believe that the families' presence and participation holds more benefits than risks to the health of children, their families, and the health care team.
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27
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Kynø NM, Fugelseth D, Knudsen LMM, Tandberg BS. Starting parenting in isolation a qualitative user-initiated study of parents' experiences with hospitalization in Neonatal Intensive Care units during the COVID-19 pandemic. PLoS One 2021; 16:e0258358. [PMID: 34714832 PMCID: PMC8555791 DOI: 10.1371/journal.pone.0258358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Worldwide, strict infection control measures including visitation regulations were implemented due to the COVID-19 pandemic at Neonatal Intensive Care Units (NICUs). These regulations gave restricted access for parents to their hospitalized infants. The consequence was limited ability to involve in the care of their infants. At Oslo University Hospital entry to NICU was denied to all except healthy mothers in March 2020. The absolute access ban for fathers lasted for 10 weeks. The aim of this study was to explore parental experiences with an infant hospitalized in the NICU during this absolute visitation ban period. METHODS We invited post discharge all parents of surviving infants that had been hospitalized for at least 14 days to participate. They were interviewed during autumn 2020 using an explorative semi-structured interview approach. Data were analyzed via inductive thematic analysis. RESULTS Nine mothers and four fathers participated. The COVID-19 regulations strongly impacted the parent's experiences of their stay. The fathers' limited access felt life-impacting. Parents struggled to become a family and raised their voices to be heard. Not being able to experience parenthood together led to emotional loneliness. The fathers struggled to learn how to care for their infant. The regulations might lead to a postponed attachment. On the other hand, of positive aspect the parents got some quietness. Being hospitalized during this first wave was experienced as exceptional and made parents seeking alliances by other parents. Social media was used to keep in contact with the outside world. CONCLUSIONS The regulations had strong negative impact on parental experiences during the NICU hospitalization. The restriction to fathers' access to the NICU acted as a significant obstacle to early infant-father bonding and led to loneliness and isolation by the mothers. Thus, these COVID-19 measures might have had adverse consequences for families.
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Affiliation(s)
- Nina M. Kynø
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
- * E-mail:
| | - Drude Fugelseth
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Bente Silnes Tandberg
- Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
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28
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Yahya NFS, Teng NIMF, Shafiee N, Juliana N. Association between Breastfeeding Attitudes and Postpartum Depression among Mothers with Premature Infants during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10915. [PMID: 34682652 PMCID: PMC8535779 DOI: 10.3390/ijerph182010915] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 12/21/2022]
Abstract
Breastfeeding is the best form of feeding for premature infants. However, mothers with premature delivery are frequently reported to be depressed, and this has been especially the case during the Coronavirus Disease-2019 (COVID-19) pandemic. We aimed to measure the level of breastfeeding attitude and its association with postpartum depression among mothers with premature infants in the Neonatal Intensive Care Unit (NICU) during the COVID-19 pandemic. A total of 248 mothers with a premature infant were observed in this cross-sectional study from the chosen NICUs of government hospitals in Selangor, Malaysia. The Iowa Infant Feeding Attitude Score (IIFAS) and the Edinburgh Postnatal Depression Scale, along with sociodemographic questionnaires, were used to obtain information on the mothers' attitudes towards breastfeeding and the risk of postpartum depression. A higher percentage of mothers had a positive attitude towards breastfeeding (64.9%), with a mean IIFAS score of 66.30 ± 6.92. Meanwhile, about 27% of mothers with premature infants were reported to have high risk of depressive symptoms. Mothers with a high risk of depression were less likely to have a positive attitude towards breastfeeding (OR 0.37, 95% CI 0.199, 0.675) as compared to mothers with a low risk of depression (p < 0.01). We found that there is an association between the risk of depression and the attitude towards breastfeeding. Early identification of maternal mental health problems should be addressed to ensure the willingness of mothers to continue breastfeeding.
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Affiliation(s)
- Noor Fairuzi Suhana Yahya
- Faculty of Health Sciences, Universiti Teknologi MARA, Bandar Puncak Alam 42300, Selangor, Malaysia; (N.F.S.Y.); (N.S.)
| | - Nur Islami Mohd Fahmi Teng
- Faculty of Health Sciences, Universiti Teknologi MARA, Bandar Puncak Alam 42300, Selangor, Malaysia; (N.F.S.Y.); (N.S.)
| | - Najwa Shafiee
- Faculty of Health Sciences, Universiti Teknologi MARA, Bandar Puncak Alam 42300, Selangor, Malaysia; (N.F.S.Y.); (N.S.)
| | - Norsham Juliana
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia;
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29
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Pilon B, Craig AK, Lemmon ME, Goeller A. Supporting families in their child's journey with neonatal encephalopathy and therapeutic hypothermia. Semin Fetal Neonatal Med 2021; 26:101278. [PMID: 34561175 PMCID: PMC9627456 DOI: 10.1016/j.siny.2021.101278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neonates and families face challenges in hypothermic therapy, including trauma to parents, extreme emotions, and unfamiliarity with the medical system. Communication is an essential element to supporting parents while their children are in the NICU, and beyond, building the foundation for the ongoing relationship the family has with the medical system. Significant consideration needs to be given to the critical element of integrating the family into the care of a baby being treated with therapeutic hypothermia. Clinicians can promote healing of accumulated traumas of parents through ensuring parent's emotional safety, facilitating a trusting relationship, and promoting parent empowerment. Connecting parents with resources, especially peer support, is an essential part of a hospital stay. In this chapter, we explore best practices to support families during and after hypothermic therapy.
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Affiliation(s)
- Betsy Pilon
- Hope for HIE, PO Box 250472, West Bloomfield, MI, 48325, USA.
| | - Alexa K. Craig
- Neonatal and Pediatric Neurology, Tufts University School of Medicine, Maine Medical Partners Pediatric Neurology, 55 Spring St, Scarborough, ME, 04074, USA
| | - Monica E. Lemmon
- Division of Pediatric Neurology, Durham, NC, USA,Developmental Medicine, Durham, NC, USA,Department of Pediatrics, Durham, NC, USA,Population Health Sciences, Durham, NC, USA,Duke University School of Medicine, Durham, NC, USA,Margolis Center for Health Policy, Duke University, DUMC 3936, Durham, NC, USA
| | - Annie Goeller
- Hope for HIE, PO Box 250472, West Bloomfield, MI, 48325, USA.
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30
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Maitre NL, Benninger KL, Neel ML, Haase JA, Pietruszewski L, Levengood K, Adderley K, Batterson N, Hague K, Lightfoot M, Weiss S, Lewandowski DJ, Larson H. Standardized Neurodevelopmental Surveillance of High-risk Infants Using Telehealth: Implementation Study during COVID-19. Pediatr Qual Saf 2021; 6:e439. [PMID: 34345752 PMCID: PMC8322542 DOI: 10.1097/pq9.0000000000000439] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/03/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Neurodevelopmental surveillance is critical for high-risk infants following neonatal intensive care discharge and is traditionally performed in-person. COVID-19 interruption of regular surveillance necessitated a rapid development of telehealth models for effective and standardized care. METHODS We used implementation science and lean methodologies to develop an effective telehealth neurodevelopmental surveillance program for high-risk infants. Interventions included reorganization of visit flow processes and a telehealth toolkit for standardized neurological and developmental assessments. We tested and improved our intervention through plan-do-study-act cycles, value-added analysis, and parent- and provider-satisfaction questionnaires. Process metrics (standard elements, subspecialty referrals, diagnostic tests, and prescriptions ordered) were compared in group-level analyses between telehealth patients (N = 97) March 16, 2020-July 1, 2020 and a matched in-person cohort at the same period the previous year. Run charts examined shifts in balancing measures (provider efficiency and missed visits) over 8 weeks before and after implementation. RESULTS Primary outcomes were visit completion (100%), patient parent satisfaction (>90% strongly agreed or agreed telehealth procedures were valuable and easy to use) and ability to accurately diagnose cerebral palsy (no statistical difference with comparison visits). Providers (N = 6) rated telehealth experiences favorably. Process metrics indicated no differences between telehealth and in-person visits (all P > 0.05). Following telehealth implementation, provider efficiency increased to near baseline (median 88.9% versus 91.7%) and median missed visits decreased to 0% from 20% (in-person). CONCLUSIONS Implementation of telehealth for neurodevelopmental surveillance in a tertiary high-risk infant follow-up clinic successfully provided standardized and timely care during stay-at-home orders; broader telehealth applications may overcome access barriers in this field.
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Affiliation(s)
- Nathalie L. Maitre
- From the Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
- Neonatology Follow Up Clinics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Kristen L. Benninger
- From the Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Mary Lauren Neel
- From the Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Jennifer A. Haase
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Lindsay Pietruszewski
- From the Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Katelyn Levengood
- From the Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Kathleen Adderley
- From the Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Nancy Batterson
- From the Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Kaleigh Hague
- From the Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Megan Lightfoot
- From the Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Sarah Weiss
- Neonatology Follow Up Clinics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Dennis J. Lewandowski
- From the Center for Perinatal Research at the Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | - Heather Larson
- Neonatal Network, Nationwide Children’s Hospital, Columbus, Ohio
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31
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Brahmbhatt K, Mournet AM, Malas N, DeSouza C, Greenblatt J, Afzal KI, Giles LL, Charoensook J, Feuer V, Raza H, Mooneyham GC, Pergjika A, Schlesinger A, Chapman A, Strain A, Gandhi B, Johnson K, Mroczkowski MM, Ibeziako P, Graham R, Yoon Y, Plioplys S, Fuchs C, Shaw RJ, Pao M. Adaptations Made to Pediatric Consultation-Liaison Psychiatry Service Delivery During the Early Months of the COVID-19 Pandemic: A North American Multisite Survey. J Acad Consult Liaison Psychiatry 2021; 62:511-521. [PMID: 34033972 PMCID: PMC8141785 DOI: 10.1016/j.jaclp.2021.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to rapid changes in clinical service delivery across hospital systems nationally. Local realities and resources were key driving factors impacting workflow changes, including for pediatric consultation-liaison psychiatry service (PCLPS) providers. OBJECTIVE This study aims to describe the early changes implemented by 22 PCLPSs from the United States and Canada during the COVID-19 pandemic. Understanding similarities and differences in adaptations made to PCLPS care delivery can inform best practices and future models of care. METHODS A 20-point survey relating to PCLPS changes during the COVID-19 pandemic was sent to professional listservs. Baseline hospital demographics, hospital and PCLPS workflow changes, and PCLPS experience were collected from March 20 to April 28, 2020, and from August 18 to September 10, 2020. Qualitative data were collected from responding sites. An exploratory thematic analysis approach was used to analyze the qualitative data that were not dependent on predetermined coding themes. Descriptive statistics were calculated using Microsoft Excel. RESULTS Twenty-two academic hospitals in the United States and Canada responded to the survey, with an average of 303 beds/hospital. Most respondents (18/22) were children's hospitals. Despite differences in regional impact of COVID-19 and resource availability, there was significant overlap in respondent experiences. Restricted visitation to one caregiver, use of virtual rounding, ongoing trainee involvement, and an overall low number of COVID-positive pediatric patients were common. While there was variability in PCLPS care delivery occurring virtually versus in person, all respondents maintained some level of on-site presence. Technological limitations and pediatric provider preference led to increased on-site presence. CONCLUSIONS To our knowledge, this is the first multicenter study exploring pandemic-related PCLPS changes in North America. Findings of this study demonstrate that PCLPSs rapidly adapted to COVID-19 realities. Common themes emerged that may serve as a model for future practice. However, important gaps in understanding their effectiveness and acceptability need to be addressed. This multisite survey highlights the importance of establishing consensus through national professional organizations to inform provider and hospital practices.
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Affiliation(s)
- Khyati Brahmbhatt
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, UCSF Weill Institute for Neurosciences, UCSF Benioff Children's Hospital, San Francisco, CA.
| | - Annabelle M Mournet
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
| | - Nasuh Malas
- University of Michigan Medical School, Department of Psychiatry and Department of Pediatrics, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Claire DeSouza
- University of Toronto, Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada
| | - Jeanne Greenblatt
- NYU Grossman School of Medicine, Departments of Child Psychiatry and Pediatrics, NYU Hassenfeld Children's Hospital and Bellevue Hospital Center, New York, NY
| | - Khalid I Afzal
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Lisa L Giles
- University of Utah School of Medicine, Departments of Pediatrics and Psychiatry, Primary Children's Hospital, Salt Lake City, UT 84113
| | - Janet Charoensook
- Children's Hospital Los Angeles, Division of Psychiatry, Los Angeles, CA
| | - Vera Feuer
- Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY
| | - Haniya Raza
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
| | | | - Alba Pergjika
- Ann and Robert H, Lurie Childrens Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago IL
| | - Amanda Schlesinger
- University of Minnesota Medical School. F262 West Building, Minneapolis, MN
| | - Andrea Chapman
- University of British Columbia, Department of Psychiatry, British Columbia Children's Hospital, Vancouver, BC
| | - Angela Strain
- The University of North Carolina at Chapel Hill, Department of Emergency Medicine, Chapel Hill, NC
| | - Bela Gandhi
- Nationwide Children's Hospital, Department of Psychiatry. 444 Butterfly Gardens Drive, Columbus, OH
| | - Kyle Johnson
- Oregon Health & Science University. Division of Child & Adolescent Psychiatry, Portland, OR
| | - Megan M Mroczkowski
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY
| | - Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston MA
| | - Regina Graham
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, UCSF Weill Institute for Neurosciences, UCSF Benioff Children's Hospital, San Francisco, CA
| | - Yesie Yoon
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, AL
| | - Sigita Plioplys
- Ann and Robert H, Lurie Childrens Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago IL
| | - Catherine Fuchs
- Vanderbilt University, Department of Psychiatry and Behavioral Sciences and Pediatrics, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Richard J Shaw
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences. 401 Quarry Road, Palo Alto, CA
| | - Maryland Pao
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
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Liu CH, Mittal L, Erdei C. COVID-19-related health worries compound the psychiatric distress experienced by families of high-risk infants. J Perinatol 2021; 41:1191-1195. [PMID: 33658613 PMCID: PMC7928184 DOI: 10.1038/s41372-021-01000-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 01/30/2021] [Accepted: 02/04/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Cindy H Liu
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carmina Erdei
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Cena L, Biban P, Janos J, Lavelli M, Langfus J, Tsai A, Youngstrom EA, Stefana A. The Collateral Impact of COVID-19 Emergency on Neonatal Intensive Care Units and Family-Centered Care: Challenges and Opportunities. Front Psychol 2021; 12:630594. [PMID: 33716895 PMCID: PMC7943863 DOI: 10.3389/fpsyg.2021.630594] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/25/2021] [Indexed: 12/28/2022] Open
Abstract
The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcare services worldwide, including those for high-risk newborns and their families. Due to the risk of contagion, critically ill infants, relatives and professionals attending neonatal intensive care units (NICUs) are undergoing a profound remodeling of the organization and quality of care. In particular, mitigation strategies adopted to combat the COVID-19 pandemic may hinder the implementation of family-centered care within the NICU. This may put newborns at risk for several adverse effects, e.g., less weight gain, more nosocomial infections, increased length of NICU stay as well as long-term worse cognitive, emotional, and social development. This article aims to contribute to deepening the knowledge on the psychological impact of COVID-19 on parents and NICU staff members based on empirical data from the literature. We also provided evidence-based indications on how to safely empower families and support NICU staff facing such a threatening emergency, while preserving the crucial role of family-centered developmental care practices.
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Affiliation(s)
- Loredana Cena
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Biban
- Department of Neonatal and Pediatric Critical Care, Verona University Hospital, Verona, Italy
| | - Jessica Janos
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Manuela Lavelli
- Department of Human Sciences, University of Verona, Verona, Italy
| | - Joshua Langfus
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Angelina Tsai
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eric A. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alberto Stefana
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Abstract
Continuous quality improvement (CQI) has become a vital component of newborn medicine. Applying core principles - robust measurement, repeated small tests of change, collaborative learning through data sharing - have led to improvements in care quality, safety, and outcomes in the Neonatal Intensive Care Unit (NICU). High-risk infant follow-up programs (HRIF) have historically aided such quality improvement efforts by providing outcomes data about NICU interventions. Though as a discipline, HRIF has not universally embraced CQI for its own practice. In this review, we summarize the history of CQI in neonatology and applications of improvement science in healthcare and describe examples of CQI in HRIF. We identify the need for consensus on what defines 'high-risk' and constitutes meaningful outcomes. Last, we outline four areas for future investment: establishing evidence-based care delivery systems, standardizing outcomes and their measures, embracing a family-centered approach prioritizing parent goals, and developing professional standards of care for HRIF.
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Affiliation(s)
- Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center Boston, 330 Brookline Avenue, Rose 3, 02215, Boston, MA, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford School of Medicine, 750 Welch Road, Suite 315, Palo Alto, 94034, Stanford, CA, USA; California Perinatal Quality Care Collaborative-California Children's Services High Risk Infant Follow-Up Quality of Care Initiative, San Francisco, CA, USA.
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Bua J, Mariani I, Girardelli M, Tomadin M, Tripani A, Travan L, Lazzerini M. Parental Stress, Depression, and Participation in Care Before and During the COVID-19 Pandemic: A Prospective Observational Study in an Italian Neonatal Intensive Care Unit. Front Pediatr 2021; 9:737089. [PMID: 34660492 PMCID: PMC8515023 DOI: 10.3389/fped.2021.737089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Recent studies reported, during the COVID-19 pandemic, increased mental distress among the general population and among women around the childbirth period. COVID-19 pandemic may undermine the vulnerable well-being of parents in Neonatal Intensive Care Units (NICUs). Objective: Our study aimed to explore whether parental stress, depression, and participation in care in an Italian NICU changed significantly over three periods: pre-pandemic (T0), low (T1), and high COVID-19 incidence (T2). Methods: Enrolled parents were assessed with the Parental Stressor Scale in the NICU (PSS:NICU), Edinburgh Postnatal Depression Scale (EPDS), and Index of Parental Participation (IPP). Stress was the study primary outcome. A sample of 108 parents, 34 for each time period, was estimated to be adequate to detect a difference in PSS:NICU stress occurrence level score (SOL) of 1.25 points between time periods. To estimate score differences among the three study periods a non-parametric analysis was performed. Correlation among scores was assessed with Spearman rank coefficient. Results: Overall, 152 parents were included in the study (62 in T0, 56 in T1, and 34 in T2). No significant differences in the median PSS:NICU, EPDS, and IPP scores were observed over the three periods, except for a slight increase in the PSS:NICU parental role sub-score in T2 (T0 3.3 [2.3-4.1] vs. T2 3.9 [3.1-4.3]; p = 0.038). In particular, the question regarding the separation from the infant resulted the most stressful aspect during T2 (T0 4.0 [4.0-5.0] vs. T2 5.0 [4.0-5.0], p = 0.008). The correlation between participation and stress scores (r = 0.19-022), and between participation and depression scores (r = 0.27) were weak, while among depression and stress, a moderate positive correlation was found (r = 0.45-0.48). Conclusions: This study suggests that parental stress and depression may be contained during the COVID-19 pandemic, while participation may be ensured.
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Affiliation(s)
- Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Martina Girardelli
- Department of Pediatrics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Murphy Tomadin
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Antonella Tripani
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Laura Travan
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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Scala M, Marchman VA, Brignoni-Pérez E, Morales MC, Travis KE. Impact of the COVID-19 pandemic on developmental care practices for infants born preterm. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 33269358 DOI: 10.1101/2020.11.25.20238956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm delivered by both families and clinical staff. METHODS We analyzed electronic medical record data from infants born at less than 32 weeks gestational age (GA) cared for in the Lucile Packard Children's Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to May 31, 2020) and the analogous period in 2019. Our final sample consisted of 52 infants ( n =27, 2019 cohort; n =25, 2020 cohort). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for GA at start of study period. RESULTS Results indicated that families of infants in the 2020 cohort visited less frequently (47% of available days) than those in the 2019 cohort (97%; p =0.001). Infants received developmental care activities less frequently in the 2020 cohort (3.51 vs. 4.72 activities per day; p =0.04), with a lower number of minutes per day (99.91 vs. 145.14; p =0.04) and a shorter duration per instance (23.41 vs. 29.65; p =0.03). Similar reductions occurred in both family- and staff-delivered developmental care activities. CONCLUSIONS The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.
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