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Grieb SM, McAtee H, Sibinga E, Mendelson T. Exploring the Influence of a Mindfulness Intervention on the Experiences of Mothers with Infants in Neonatal Intensive Care Units. Mindfulness (N Y) 2023; 14:218-229. [PMID: 36684062 PMCID: PMC9838379 DOI: 10.1007/s12671-022-02060-w] [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] [Accepted: 12/18/2022] [Indexed: 01/11/2023]
Abstract
Objectives Mothers with infants in the neonatal intensive care unit (NICU) are at increased risk of psychological distress, which can have lasting negative impacts on both mother and infant. However, few interventions are available to promote these mothers' mental health and wellbeing. In the context of a pilot randomized controlled trial testing a mindfulness intervention for mothers with infants in the NICU, we explore the experiences of the mothers participating in the mindfulness-based intervention, with mothers in the control group as comparison, and the ways they felt it influenced their time in the NICU. Method Twenty-six participants (15 participants in the intervention arm and 11 participants in the control arm) recruited from two NICUs in an urban center in Eastern United States completed semi-structured interviews. Interviews explored the mothers' NICU experience as well as experience with the mindfulness and health education (control) programs. Data was analyzed using an iterative, thematic constant comparison process informed by grounded theory. Results Mothers reported that participation in the mindfulness intervention helped them to calm the chaos through recentering and fostering connections, find comfort through non-judgmental acceptance, gain perspective on the situation, and facilitate self-care. These were experienced only among the mothers in the intervention arm. These themes did not vary based on demographics of the mothers in the mindfulness study arm or their pre-study awareness of mindfulness. Conclusions Mindfulness interventions may foster new practices and perspectives for mothers with infants in the NICU, potentially leading to improved mental health wellbeing.
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Affiliation(s)
- Suzanne M. Grieb
- Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Ave., Mason F. Lord Center Bldg, Suite 4200, Baltimore, MD 21224 USA
| | - Hannah McAtee
- General Pediatrics, Johns Hopkins All Children’s Hospital, 601 5th Street South, St. Petersburg, FL 33701 USA
| | - Erica Sibinga
- Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins University School of Medicine, 5200 Eastern Ave., Mason F. Lord Center Bldg, Suite 4200, Baltimore, MD 21224 USA
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Hampton House 853, Baltimore, MD 21205 USA
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Kestler-Peleg M, Stenger V, Lavenda O, Bendett H, Alhalel-Lederman S, Maayan-Metzger A, Strauss T. "I'll Be There": Informal and Formal Support Systems and Mothers' Psychological Distress during NICU Hospitalization. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121958. [PMID: 36553401 PMCID: PMC9777094 DOI: 10.3390/children9121958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
Mothers of infants hospitalized in the Neonatal Intensive Care Unit (NICU) are at a high risk for psychological distress, which is of concern to health and social professionals due to the negative implications for mothers and infants. A model for explaining maternal psychological distress, consisting of intolerance to uncertainty and support from informal (spouse, family, and friends) and formal (medical staff) systems was examined. Data was collected from one of the largest NICUs in Israel; 129 mothers of 215 preterm infants completed self-report questionnaires regarding their background variables, intolerance to uncertainty, perceived informal support and perceived medical staff support. The NICU's medical staff provided indicators for the infants of participating mothers. A hierarchical multiple regression analysis was conducted. The examined model explained 29.2% of the variance in maternal psychological distress. Intolerance of uncertainty positively predicted psychological distress. Informal support, and in particular, spousal support negatively predicted psychological distress above and beyond intolerance of uncertainty. Medical staff support negatively predicted psychological distress above and beyond intolerance to uncertainty and informal support. Our findings suggest that maternal psychological distress is reduced through a family-centered care approach in NICUs. Medical professionals and social services should develop further solutions for addressing preterm mothers' need for certainty and support.
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Affiliation(s)
- Miri Kestler-Peleg
- School of Social Work, Ariel University, Ariel 40700, Israel
- Correspondence:
| | - Varda Stenger
- Department of Neonatology, Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Osnat Lavenda
- School of Social Work, Ariel University, Ariel 40700, Israel
| | - Haya Bendett
- Department of Neonatology, Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Shanee Alhalel-Lederman
- Department of Neonatology, Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Ayala Maayan-Metzger
- Department of Neonatology, Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Tzipora Strauss
- Department of Neonatology, Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
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Boni L, Gradellini C, Miari M, Cocconi P, Montorsi A, Capone R, Costi S, Di Leo S, Puglisi C, Ghirotto L. How parents and health professionals experience prematurity in an Italian neonatal intensive care: A grounded theory study. J Pediatr Nurs 2022; 67:e172-e179. [PMID: 35987669 DOI: 10.1016/j.pedn.2022.07.020] [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: 03/18/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to explore prematurity as a psycho-social process from the point of view of both parents and healthcare professionals. DESIGN AND METHODS We conducted a Grounded Theory study through semi-structured interviews. Participants were from an Italian Neonatal Intensive Care Unit, including parents of premature children, and health professionals. Interviews were analyzed according to Grounded Theory coding strategies, to hypothesize a theoretical model. RESULTS On one side, behaviors, emotions, and feelings of parental couples; on the other one, the activities and reactions of professionals have been interpreted in a four-phase negotiated process: 1) the initial breakup; 2) the floating family; 3) the event processing; 4) the reconstruction of a new family. CONCLUSIONS Managing prematurity is a negotiated process which could be better managed through a family-centered approach as fundamental in neonatal and pediatric services. Being open in listening, coherent in the given answers, and knowing the entire process and story of being suddenly parents of a premature child can make the difference in the future definition of a new family. PRACTICE IMPLICATIONS Perinatal care would benefit from the following suggested practical implications: i) reducing feelings of separation and solitude by integrating diverse professionals around the family systems; ii) expediting prematurity-related changes through peer-support during hospitalization and attention to rooms' organization; iii) enhancing information exchange between all professionals involved in the care of dyads/parents and new-borns, starting since the pregnancy and continuing after the child's birth by implementing multidisciplinary meetings or appropriate care pathways.
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Affiliation(s)
- Laura Boni
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, via Giovanni Amendola 2, 42122 Reggio Emilia, Italy
| | - Cinzia Gradellini
- Qualitative Research Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; Nursing Course, University of Modena and Reggio Emilia, Italy.
| | - Monica Miari
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | | | - Annalisa Montorsi
- Ospedale Sassuolo SpA, via Francesco Ruini 2, 41049 Sassuolo, Modena, Italy
| | - Roberto Capone
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Stefania Costi
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Silvia Di Leo
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Chiara Puglisi
- Reserach Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Luca Ghirotto
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
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Types, Evidence, and Resources of Interventions Focused on Improving the Psychosocial Well-being of Parents of Premature/Sick Infants: A Scoping Review. Adv Neonatal Care 2022; 22:E138-E151. [PMID: 34224480 DOI: 10.1097/anc.0000000000000913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Parents of infants born premature and/or sick and who require neonatal care are at risk of poor mental health. Currently, there is no comprehensive knowledge about interventions (ie, types, evidence, resources) that have been exclusively designed to improve the psychosocial well-being of this population group. PURPOSE To undertake a systematic scoping review of interventions focused on improving the psychosocial well-being of parents of sick/premature infants who required neonatal care to identify the ( a ) types of interventions, ( b ) evidence of the interventions, and ( c ) level of resources required to deliver the interventions. SEARCH STRATEGY e searched 7 databases (MEDLINE, CINAHL, PsycINFO, Cochrane, EMBASE, Web of Science, and Global Index), reviewed references, and followed up key authors. RESULTS From 10,516 hits, 38 articles met the inclusion criteria (36 different studies/interventions). Studies included creative oriented (n = 11), group/peer support (n = 4), relaxation/mindfulness (n = 3), spiritual/religious (n = 4), psychotherapeutic-based (n = 11), and "other" (n = 3) (eg, sleep, acupuncture). Most had been undertaken in high-income settings with mothers and required varying levels of resources within and between the different intervention types. While some interventions were effective, there was high heterogeneity with similar interventions using different designs, protocols, and outcomes. Most intervention types included studies that highlighted what parents valued (eg, self-care, relaxation, social opportunities). IMPLICATIONS FOR RESEARCH Evidence highlights a wide range of potential interventions for nursing and other specialist staff to consider and offers insights into potential mechanisms of effectiveness to underpin future intervention design.
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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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McLoughlin A, Wilson C, Swords L. Parents' Experiences of Their Child's Solid-Organ Transplant: A Meta-Ethnography of Qualitative Studies. J Pediatr Psychol 2021; 47:279-291. [PMID: 34664643 DOI: 10.1093/jpepsy/jsab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this paper was to conduct a systematic review and meta-ethnography of qualitative studies examining the experiences of parents adjusting to life after the solid organ transplant (SOT) of their child. METHODS A systematic review of the literature was conducted to identify qualitative studies that examined this topic. The search retrieved 4,964 studies to review against inclusion criteria. A total of 21 studies were included in the meta-ethnography. A reciprocal translation was conducted to compare themes identified in each study. A line of argument synthesis was then conducted in order to integrate the similarities and differences between all of the studies into a new interpretative context. RESULTS The synthesis identified four themes: (a) adjusting to life after transplant, (b) factors that facilitate adjustment, (c) factors that disrupt adjustment, and (d) changes caused by transplant. As a result of the synthesis, a new interpretation of parents' experiences of adjusting to life after the SOT of their child was constructed. A summary figure is presented. CONCLUSION This review found that while parents may struggle to adapt to life post-transplant and the demands of caring for their child, the experience can also result in the development of new skills, a new appreciation for life, and viewing the self in a more positive manner. A better understanding of parental experiences will promote the development of more effective interventions for the adjustment of parents and families to post-transplant life.
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Alinejad-Naeini M, Peyrovi H, Shoghi M. Self-reinforcement: Coping strategies of Iranian mothers with preterm neonate during maternal role attainment in NICU; A qualitative study. Midwifery 2021; 101:103052. [PMID: 34102556 DOI: 10.1016/j.midw.2021.103052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Having a preterm neonate in the neonatal intensive care unit (NICU) is one of the most stressful experience for parents. In facing these stressors, mothers need to find ways to adapt and control resources to maintain stability. The aim of this paper is to report coping strategies of mothers with preterm neonate during maternal role attainment in NICU. METHODS This paper reports a part of the findings of a grounded theory study that investigated how the mothers of preterm neonates go through maternal role attainment. The data were collected through in-depth semi-structured interviews with 12 mothers with preterm neonate admitted to the NICU and 5 nurses working in NICU. Data were analyzed according to Corbin and Strauss's (2015) approach using constant comparative analysis technique. FINDINGS Four themes, emerged from experiences of the participants, formed the concept of "Self-reinforcement" as the prominent strategy of mothers: "support seeking", "Spiritual getting in the mood", "Hope creation" and "Getting energy from the baby". CONCLUSION These findings showed that mothers use strategies to calm and support themselves and their neonates, and recognize that their lives had changed and need to adjust to their new circumstances.
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Affiliation(s)
- Mona Alinejad-Naeini
- Nursing Care Research Center, Pediatric and Intensive Neonatal Nursing Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Hamid Peyrovi
- Nursing Care Resarch Center and Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Mahnaz Shoghi
- Nursing Care Research Center, Pediatric and Intensive Neonatal Nursing Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
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Menke BM, Hass J, Diener C, Pöschl J. Family-centered music therapy-Empowering premature infants and their primary caregivers through music: Results of a pilot study. PLoS One 2021; 16:e0250071. [PMID: 33989286 PMCID: PMC8121291 DOI: 10.1371/journal.pone.0250071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Neonatal Intensive Care Units (NICUs) premature infants are exposed to various acoustic, environmental and emotional stressors which have a negative impact on their development and the mental health of their parents. Family-centred music therapy bears the potential to positively influence these stressors. The few existing studies indicate that interactive live-improvised music therapy interventions both reduce parental stress factors and support preterm infants' development. METHODS The present randomized controlled longitudinal study (RCT) with very low and extremely low birth weight infants (born <30+0 weeks of gestation) and their parents analyzed the influence of music therapy on both the physiological development of premature infants and parental stress factors. In addition, possible interrelations between infant development and parental stress were explored. 65 parent-infant-pairs were enrolled in the study. The treatment group received music therapy twice a week from the 21st day of life till discharge from hospital. The control group received treatment as usual. RESULTS Compared to the control group, infants in the treatment group showed a 11.1 days shortening of caffeine therapy, 12.1 days shortening of nasogastric/ orogastric tube feed and 15.5 days shortening of hospitalization, on average. While these differences were not statistically significant, a factor-analytical compound measure of all three therapy durations was. From pre-to-post-intervention, parents showed a significant reduction in stress factors. However, there were no differences between control and treatment group. A regression analysis showed links between parental stress factors and physiological development of the infants. CONCLUSION This pilot study suggests that a live-improvised interactive music therapy intervention for extremely and very preterm infants and their parents may have a beneficial effect on the therapy duration needed for premature infants before discharge from hospital is possible. The study identified components of the original physiological variables of the infants as appropriate endpoints and suggested a slight change in study design to capture possible effects of music therapy on infants' development as well. Further studies should assess both short-term and long-term effects on premature infants as well as on maternal and paternal health outcomes, to determine whether a family-centered music therapy, actually experienced as an added value to developmental care, should be part of routine care at the NICU.
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Affiliation(s)
- Barbara M. Menke
- Department of Neonatology, University Children’s Hospital, Heidelberg, Germany
- Institute for Applied Research, SRH University Heidelberg, Heidelberg, Germany
| | - Joachim Hass
- Institute for Applied Research, SRH University Heidelberg, Heidelberg, Germany
- Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Carsten Diener
- Institute for Applied Research, SRH University Heidelberg, Heidelberg, Germany
| | - Johannes Pöschl
- Department of Neonatology, University Children’s Hospital, Heidelberg, Germany
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Tuyisenge D, Byiringiro S, Manirakiza ML, Mutsinzi RG, Nshimyiryo A, Nyishime M, Hirschhorn LR, Biziyaremye F, Gitera J, Beck K, Kirk CM. Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda. BMC Pediatr 2021; 21:89. [PMID: 33607961 PMCID: PMC7893907 DOI: 10.1186/s12887-021-02544-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable. Poor quality of care is a major driver of neonatal mortality in low- and middle-income countries. The All Babies Count (ABC) intervention was designed to reduce neonatal mortality through provision of equipment and supplies, training, mentorship, and data-driven quality improvement (QI) with peer-to-peer learning through learning collaborative sessions (LCS). We aim to describe the ABC scale-up in seven rural district hospitals from 2017 to 2019 focusing on the QI strategies implemented in hospital neonatal care units (NCUs) and the resultant neonatal care outcomes. METHODS A pre-post quasi experimental study was conducted in 7 rural hospitals in Rwanda in two phases. The baseline periods were April-June 2017 for Phase I and July-September 2017 for Phase II; with end-line data collected during the same periods in 2019. Data included facility audits of supplies and staffing, LCS surveys of QI skills, and reports of implemented QI change ideas. Data on NCU admissions and deaths were extracted from Health Management Information System (HMIS). Facility-reported change ideas were coded into common themes. Changes in post-post neonatal mortality were measured using Chi-squared tests. RESULTS NCUs were run by a median of 1 nurse [interquartile range (IQR):1-2] at baseline and endline. Median NCU admissions increased from 121 [IQR: 77-155] to 137 [IQR: 79-184]. Availability of advanced equipment improved (syringe pumps: 57-100 %, vital sign monitors: 51-100 % and CPAP machine: 14-100 %). There were significant improvements in QI skills among NCU staff. All 7 NCUs (100 %) addressed non-adherence to protocol as a priority gap, 5 NCUs (86 %) also improved communication with families. NCU case fatality rate declined from 12.4 to 7.8 % (p = 0.001). CONCLUSIONS The ABC package of interventions combining the provision of essential equipment to NCU, clinical training and strong mentorship, QI coaching, and the LCS approach for peer-to-peer learning was associated with significant neonatal mortality reduction and services utilization in the intervention hospitals.
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Affiliation(s)
- David Tuyisenge
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda.
| | | | | | | | | | - Merab Nyishime
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda
| | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, 625 N Michigan Avenue, 60611, Chicago, IL, USA
| | | | | | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda
| | - Catherine M Kirk
- Partners In Health/Inshuti Mu Buzima, PO. Box 3432, Kigali, Rwanda
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Yang R, Chen D, Deng Q, Xu X. The effect of donor human milk on the length of hospital stay in very low birthweight infants: a systematic review and meta-analysis. Int Breastfeed J 2020; 15:89. [PMID: 33115488 PMCID: PMC7594457 DOI: 10.1186/s13006-020-00332-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Donor human milk (DHM) is an alternative to preterm infant formula if the mother's own milk is not available. Since the lactation period and preservation treatment of DHM are different from those of mother's own milk, we aimed to determine the reduction in the length of hospital stay by DHM compared to preterm infant formula. METHODS In this systematic review, we searched PubMed/MEDLINE, EMBASE, and the Cochrane Library to retrieve studies on the impact of DHM on the clinical outcomes of preterm infants published before 1 November 2019. The study included very low birthweight (VLBW) infants taking either DHM or infant formula with data on the length of hospital stay. Data were analysed using Review Manager 5.3 software. RESULTS The literature search yielded 136 articles, and four randomised controlled trials (RCTs) and eight observational studies met the inclusion criteria. A meta-analysis of the RCTs (N = 725) showed no reduction in the length of hospital stay in both the DHM and infant formula groups (- 0.22 days; 95% CI -6.38, 5.95 days), whereas that of the eight observational studies (N = 2496) showed a significant reduction in the length of hospital stay in the DHM group (- 11.72 days; 95% CI -22.07, - 1.37 days). A subgroup analysis of the RCTs revealed that the incidence of necrotising enterocolitis (NEC) was significantly lower in the DHM group when the analysis included high-quality RCTs (RR = 0.32; 95% CI 0.15, 0.69). CONCLUSIONS This systematic review of RCTs showed that DHM neither prolonged nor shortened the length of hospital stay in VLBW infants compared to preterm infant formula; however, it reduced the incidence of NEC, further validating the protective role of DHM in the health and safety of VLBW infants.
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Affiliation(s)
- Rui Yang
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Danqi Chen
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qingqi Deng
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinfen Xu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
- Haining Maternal and Child Health Hospital, Branch of Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Neonatal Admission and Its Relationship to Maternal Pain: Pain Scores and Analgesia. J Perinat Neonatal Nurs 2020; 34:66-71. [PMID: 31996647 DOI: 10.1097/jpn.0000000000000452] [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: 11/26/2022]
Abstract
The aim of this study was to determine whether postnatal women whose babies required neonatal intensive care unit (NICU) admission self-reported lower pain scores and required less analgesia than women whose babies remained with them. A prospective matched audit comparing pain scores and analgesia requirements where every woman with a baby admitted to the NICU was matched to 2 women whose babies remained on the ward was undertaken. Matches were based on age, number of previous births, type of birth, episiotomy, and epidural or spinal analgesia use. Data were collected on pain scores and analgesia administered in the first 72 hours postbirth. A total of 150 women were recruited and matched from November 2015 to May 2017. No statistically significant differences were found between the 2 groups for opiate analgesia use (P = .91) or pain scores (P = .89). Regardless of NICU admission, significantly higher pain scores were reported in participants who had episiotomies (P = .03). Birth via cesarean birth resulted in significantly higher pain scores (P < .01) and greater opiate administration (P < .01). This study found no statistically significant difference between pain scores or analgesia use of mothers whose babies required NICU admission and mothers whose babies remained with them.
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Joseph R, Wellings A, Votta G. Mindfulness-Based Strategies: A Cost-Effective Stress Reduction Method for Parents in the NICU. Neonatal Netw 2019; 38:135-143. [PMID: 31470380 DOI: 10.1891/0730-0832.38.3.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Stress in parents who have an infant in the NICU is well documented in literature. Prematurity and related comorbid conditions, high-tech NICU environments, presence of multidisciplinary health care professionals, altered parenting roles, and concerns of health outcomes in the infant are common stress factors. Further, inadequate management of stress can result in poor parent-infant bonding, poor infant outcome, and postpartum depression in parents. Effective stress management strategies may help parents adapt to their parental role thereby improving infant outcomes. Research has shown mindfulness-based strategies help reduce stress in the general population. Can this strategy be applied in the context of parents of infants in the NICU? Literature is scant on the impact of mindfulness-based strategies on parents of infants in the NICU and on the infant's health outcomes. This article explores the application of mindfulness-based strategies to reduce stress in parents of infants in the NICU.
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Ireland S, Ray RA, Larkins S, Woodward L. Perspectives of time: a qualitative study of the experiences of parents of critically ill newborns in the neonatal nursery in North Queensland interviewed several years after the admission. BMJ Open 2019; 9:e026344. [PMID: 31092655 PMCID: PMC6530444 DOI: 10.1136/bmjopen-2018-026344] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
DESIGN A qualitative study informed by grounded theory principles to explore the experiences of parents who had extremely preterm or babies with antenatally diagnosed life-threatening diagnoses who were cared for in a regional tertiary neonatal unit. The study was conducted when the child was old enough to be diagnosed with long-term neurodevelopmental or medical sequelae. SETTING North Queensland is a large area in Eastern Australia of 500 000 km2, which is served by one tertiary neonatal unit. PARTICIPANTS Seventeen families representing 21 extremely preterm babies and one baby with congenital malformations who was not expected to survive prior to delivery (but did) were interviewed using grounded theory principles. Interviews were coded and themes derived. RESULTS Parents who recollect their neonatal experiences from 3 to 7 years after the baby was cared for in the neonatal intensive care described negative themes of grief and loss, guilt and disempowerment. Positive enhancers of care included parental strengths, religion and culture, family supports and neonatal unit practices. Novel findings included that prior pregnancy loss and infertility formed part of the narrative for parents, and hope was engendered by religion for parents who did not usually have a religious faith. CONCLUSIONS An understanding of both the negative aspects of neonatal care and the positive enhancers is necessary to improve the neonatal experience for parents. Parents are able to contextualise their previous neonatal experiences within both the long-term outcome for the child and their own life history.
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Affiliation(s)
- Susan Ireland
- James Cook University College of Medicine and Dentistry, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Robin A Ray
- James Cook University College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - Sarah Larkins
- James Cook University College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - Lynn Woodward
- James Cook University College of Medicine and Dentistry, Townsville, Queensland, Australia
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Fry TJ, Marfurt S, Wengier S. Systematic Review of Quality Improvement Initiatives Related to Cue-Based Feeding in Preterm Infants. Nurs Womens Health 2018; 22:401-410. [PMID: 30138603 DOI: 10.1016/j.nwh.2018.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 07/08/2018] [Accepted: 07/01/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine and synthesize the outcomes of quality improvement (QI) initiatives related to cue-based feeding of preterm infants to facilitate implementation of findings to improve nursing practice. DATA SOURCES Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete and PubMed were searched for full-text articles published from 2000 through 2017 included under the medical subject heading quality improvement and whose titles included any form of the term feeding combined with any of the following: bottle, breast, cue-based, demand, infant, neonate, newborn, oral, or responsive. STUDY SELECTION Articles were considered for inclusion if they were published in English-language journals and focused on QI initiatives concerning cue-based feeding of preterm infants in NICU settings. DATA EXTRACTION After initial article review, we examined clinical outcomes and assessed study methodology using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS) framework. DATA SYNTHESIS Our review yielded seven studies related to cue-based feeding of preterm infants. Five studies included multidisciplinary stakeholder teams to assess their respective NICU environments and facilitate project completion. In two studies, feeding "champions" were designated as facilitators. In one study, researchers used a Plan-Do-Study-Act approach and emphasized process over outcome. In six studies, researchers measured hospital length of stay, which decreased in five intervention groups. In three studies, researchers measured infant weight gain, which increased in two intervention groups. In two studies, researchers monitored weight gain velocity, and in five studies, researchers reported earlier gestational attainment of full oral feedings. CONCLUSION Weight gain, time to full oral feedings, and hospital length of stay may be improved with the use of cue-based feeding. QI initiatives are a practical means to bring best evidence and multidisciplinary collaboration to the NICU.
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Gallagher K, Shaw C, Aladangady N, Marlow N. Parental experience of interaction with healthcare professionals during their infant's stay in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2018; 103:F343-F348. [PMID: 28970318 DOI: 10.1136/archdischild-2016-312278] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 07/22/2017] [Accepted: 08/11/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To explore the experiences of parents of infants admitted to the neonatal intensive care unit towards interaction with healthcare professionals during their infants critical care. DESIGN Semi-structured interviews were conducted with parents of critically ill infants admitted to neonatal intensive care and prospectively enrolled in a study of communication in critical care decision making. Interviews were transcribed verbatim and uploaded into NVivo V.10 to manage and facilitate data analysis. Thematic analysis identified themes representing the data. RESULTS Nineteen interviews conducted with 14 families identified 4 themes: (1) initial impact of admission affecting transition into the neonatal unit; (2) impact of consistency of care, care givers and information giving; (3) impact of communication in facilitating or hindering parental autonomy, trust, parental expectations and interactions; (4) parental perception of respect and humane touches on the neonatal unit. CONCLUSION Factors including the context of infant admission, interprofessional consistency, humane touches of staff and the transition into the culture of the neonatal unit are important issues for parents. These issues warrant further investigation to facilitate individualised family needs, attachment between parents and their baby and the professional team.
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Affiliation(s)
- Katie Gallagher
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Chloe Shaw
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Narendra Aladangady
- Neonatal Unit, Homerton University Hospital NHS Foundation Trust, Homerton Row, London and Queen Mary's University of London, London, UK
| | - Neil Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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Posttraumatic Stress in Mothers While Their Preterm Infants Are in the Newborn Intensive Care Unit: A Mixed Research Synthesis. ANS Adv Nurs Sci 2018; 40:337-355. [PMID: 28825932 DOI: 10.1097/ans.0000000000000176] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this mixed research synthesis on posttraumatic stress in mothers related to their preterm infants' stay in the newborn intensive care unit (NICU), we synthesized and integrated a total of 37 studies, 25 of which were quantitative and 12 were qualitative studies. The prevalence rates of NICU mothers with elevated posttraumatic stress symptoms ranged from 18% in the United States to 81% in Turkey. Nine of the 12 studies testing interventions to decrease mothers' stress related to their NICU experiences reported significant results. Content analysis of the qualitative studies' findings revealed 5 themes: stark contrast to images of joyous motherhood, cultural overlay, issues of ownership and control, support, and learning to be a NICU mother.
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Mindfulness-Based Neurodevelopmental Care: Impact on NICU Parent Stress and Infant Length of Stay; A Randomized Controlled Pilot Study. Adv Neonatal Care 2018; 18:E12-E22. [PMID: 29595555 DOI: 10.1097/anc.0000000000000474] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND/PURPOSE Experiences of premature birth and neonatal intensive care unit (NICU) hospitalizations result in stress and family separation that have far-reaching implications. Prior studies of neonatal neurodevelopmental care show improved infant outcomes. Previous studies of mindfulness show improved stress and health outcomes in varied disease processes. No neonatal studies of parent training in mindfulness-based neurodevelopmental care exist. This study examines the impact of parent education and participation in mindfulness-based neurodevelopmental care on parent outcomes (stress, bonding, and satisfaction) and infant length of stay (LOS). METHODS This randomized controlled trial pilot study utilized a convenience sample of 55 parent-infant dyads. Parametric and nonparametric statistical tests examined differences in and between study groups in demographics and dependent study variables (stress, bonding, satisfaction, and LOS). RESULTS No statistically significant differences in parent outcomes were seen between groups. However, experimental group (EG) parents showed a significant reduction in stress scores from enrollment to discharge (P = .012) and EG infants had significantly shorter LOS (P = .026-.047) than control. IMPLICATIONS FOR PRACTICE AND RESEARCH While further research to confirm study results is warranted, changes in current NICU practices to incorporate additional parent education in mindfulness-based neurodevelopmental care may help alleviate parent stress and decrease LOS that impact financial, physical, and psychosocial outcomes for patients, families, healthcare systems, and society.
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