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Schmid SV, Arnold C, Jaisli S, Bubl B, Harju E, Kidszun A. Parents' and neonatal healthcare professionals' views on barriers and facilitators to parental presence in the neonatal unit: a qualitative study. BMC Pediatr 2024; 24:268. [PMID: 38658901 PMCID: PMC11040849 DOI: 10.1186/s12887-024-04758-3] [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: 12/01/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Parent and infant separation in the neonatal unit is associated with adverse health outcomes. Family-integrated care has several advantages and the potential to reduce these adverse outcomes but requires parental presence. This study aimed to explore the views of parents and neonatal healthcare professionals (nHCPs) on barriers and facilitators to parental presence in a Swiss neonatal unit and to identify possible differences between nHCPs and parents, and between mothers and fathers. METHODS Data were collected through semi-structured interviews with parents and focus group discussions with nHCPs. Inductive content analysis was used to identify barriers and facilitators to parental presence in the neonatal unit. RESULTS Twenty parents (10 mothers and 10 fathers) and 21 nHCPs (10 nurses and 11 physicians) participated in the study. Parents and nHCPs experienced barriers and facilitators related to: (1) Structural factors of the institution, such as infrastructure or travel and distance to the neonatal unit. (2) Organization and time management of parental presence, daily activities, and work. (3) Resources, which include factors related to the legal situation, support services, family, and friends. (4) Physical and psychological aspects, such as pain, which mainly affected mothers, and aspects of emotional distress, which affected both parents. Self-care was an important physical and psychological facilitator. (5) Parent-professional interaction. Parental presence was influenced by communication, relationship, and interaction in infant care; and (6) Cultural aspects and language. Some perspectives differed between mothers and fathers, while the overall views of parents and nHCPs provided complementary rather than conflicting insights. Using visit plans to support the organization, educating nHCPs in knowledge skills and available resources to improve encouragement and information to parents, strengthening parent self-care, and improving nHCPs' attitudes towards parental presence were seen as possible improvements. CONCLUSIONS Multifactorial barriers and facilitators determine parental presence and experience in the neonatal unit. Parents and nHCPs made specific recommendations to improve parental presence.
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Affiliation(s)
- Stephanie Vanessa Schmid
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Lucerne, 6002, Switzerland
| | - Christine Arnold
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland.
| | - Sophie Jaisli
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
| | - Benedikt Bubl
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
| | - Erika Harju
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Lucerne, 6002, Switzerland
- School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8401, Switzerland
| | - André Kidszun
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
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Barnes S, Macdonald I, Rahmaty Z, de Goumoëns V, Grandjean C, Jaques C, Ramelet AS. Effectiveness and family experiences of interventions promoting partnerships between families and pediatric and neonatal intensive care units: a mixed methods systematic review. JBI Evid Synth 2024:02174543-990000000-00290. [PMID: 38505961 DOI: 10.11124/jbies-23-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The objective of this mixed methods review was to examine the effectiveness and family experiences of interventions promoting partnerships between families and the multidisciplinary health care team in pediatric and neonatal intensive care units. INTRODUCTION Hospitalization of infants and children in neonatal intensive care units and pediatric intensive care units has a significant effect on their families, including increased stress, anxiety, and depression. Available evidence syntheses focused on specific family-centered care, but not on partnership, which is another aspect that may improve the families' outcomes and experiences. INCLUSION CRITERIA This review focused on effectiveness and experiences of interventions by health professionals in partnership with families of infants or children hospitalized in an intensive care unit. The type of intervention was a partnership between the health care team and the family, and focused on outcomes of stress, anxiety, depression, quality of life, attachment, or satisfaction with family-centered care. METHODS The JBI methodology for convergent segregated mixed methods systematic reviews was followed using the standardized JBI critical appraisal and data extraction tools. Ten databases were searched from January 2000 to April 2022. Findings of quantitative studies were statistically pooled through meta-analyses and those that could not pooled were reported in a narrative format. Qualitative studies were pooled through meta-synthesis. RESULTS This review included 6 qualitative and 42 quantitative studies. There was mixed methodological quality and all studies were included regardless of methodological quality. Meta-analyses showed positive improvements in anxiety, satisfaction with family-centered care, and stress, yet no conclusive effects in attachment and depression. These results should be interpreted with caution due to high heterogeneity. Qualitative analysis resulted in 2 synthesized findings: "Interventions that incorporate partnerships between families and the health care team can improve the family's experience and capacity to care for the child" and "Having a child in intensive care can be an experience of significant impact for families" Integration of quantitative and qualitative evidence revealed some congruence between findings; however, the paucity of qualitative evidence minimized the depth of this integration. CONCLUSIONS Partnership interventions can have a positive impact on parents of children in intensive care units, with improvements seen in stress, anxiety, and satisfaction with family-centered care. REVIEW REGISTRATION PROSPERO CRD42019137834.
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Affiliation(s)
- Shannon Barnes
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Ibo Macdonald
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Zahra Rahmaty
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Véronique de Goumoëns
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- La Source School of Nursing, HES-SO, University of Applied Sciences and Arts Western Switzerland, Lausanne Switzerland
| | - Chantal Grandjean
- Pediatric Intensive Care Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Cécile Jaques
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
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Rodrigo R, Amir LH, Forster DA. Parents' Views on Prolonged Maternal Hospital Stay With Sick Newborn Infants in a Tertiary Neonatal Unit in Sri Lanka. Adv Neonatal Care 2024; 24:162-171. [PMID: 38545806 DOI: 10.1097/anc.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Mothers of infants in most Sri Lankan neonatal units are required to be "inpatients" during the entirety of their infant's stay. This traditional practice is closely aligned to the relatively newer model of family-integrated care. PURPOSE Exploration of parent's views regarding the expectation for mothers to remain in hospital for the entire duration of their infant's neonatal unit stay. METHODS Cross-sectional study of parents of infants admitted to the University neonatal unit of Colombo North Teaching Hospital, Ragama, Sri Lanka, using self-administered questionnaires in 2017. RESULTS We found that 40% (19/48) of mothers and 43% (16/37) of fathers preferred that mothers traveled from home, rather than being inpatients continuously, in order to care for older children, receive psychological support from family, and also due to other practical inconveniences of living in the hospital. The main barriers to women being able to travel from home were the need to safely provide expressed human milk for their hospitalized infants and current hospital administrative and societal attitudes. IMPLICATIONS FOR PRACTICE AND RESEARCH We found that a considerable number of parents with infants in the neonatal intensive care unit in Sri Lanka would like the option of the mother being able travel from home, rather than being confined to hospital. To facilitate this option, changes in hospital protocols and further research into storage and transportation of expressed mother's milk will be required. Improving facilities in hospital and providing more opportunities for families to interact with infants in neonatal intensive care unit will encourage mothers to remain in hospital continuously.
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Affiliation(s)
- Ranmali Rodrigo
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Melbourne, Victoria, Australia (Drs Rodrigo, Amir, and Forster); Department of Paediatrics, University of Kelaniya, Ragama, Sri Lanka (Dr Rodrigo); Department of Paediatrics, Mercy Hospital for Women, Heidelberg, Melbourne, Australia (Dr Rodrigo); and Midwifery and Maternity Services Research, The Royal Women's Hospital, Parkville, Melbourne, Australia (Dr Forster)
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Zhang Y, Jiang M, Wang S, Xiang X, He W, Du J, Hei M. Effect of family integrated care on stress in mothers of preterm infants: A multicenter cluster randomized controlled trial. J Affect Disord 2024; 350:304-312. [PMID: 38232775 DOI: 10.1016/j.jad.2024.01.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/23/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Reducing mother-infant separation in early life is a key breakthrough in the care improvement model in the neonatal intensive care unit (NICU). Previously, we reported effect of family integrated care (FICare) on clinical outcomes of preterm infants. We further clarify effect of FICare on maternal stress. METHODS Mothers of preterm infants at eleven NICUs were randomized to the FICare group and the control group. The primary outcome was the reduction in Parental Stress Scale: NICU (PSS:NICU) score from enrollment to discharge. RESULTS Total of 601 mothers (298 in FICare and 303 in control groups) enrolled. There was no significant difference in PSS:NICU score between the 2 groups at enrollment (P = 0.824), and the FICare group had lower scores at discharge (P < 0.001). PSS:NICU scores of both groups were significantly decreased at discharge compared to at enrollment (P < 0.001), and the reduction was greater in the FICare group (P < 0.001). After applying linear regressions to adjust for potential confounders, results remained unchanged (adjusted P < 0.001). PSS:NICU score reductions from enrollment to discharge were positively correlated with maternal age in the control group (ρ = 0.147, P = 0.011). LIMITATIONS This study was limited to post-hoc analyses and did not include follow-up to evaluate long-term effects. CONCLUSIONS FICare is helpful for reducing maternal stress in preterm infants in the NICU. Older mothers tend to have limited improvements in stress after traditional nonparent care, which suggests that they may benefit more from the FICare model.
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Affiliation(s)
- Yuan Zhang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China
| | - Min Jiang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China
| | - Shu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiying Xiang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China
| | - Wenwen He
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China
| | - Juan Du
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China
| | - Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China.
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Tiryaki Ö, Çınar N, Caner İ. The effect of family integrated care on preparing parents with premature infants hospitalized in the neonatal intensive care unit for discharge. J Perinatol 2024:10.1038/s41372-024-01931-5. [PMID: 38499753 DOI: 10.1038/s41372-024-01931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE The study was designed as a randomized controlled experimental trial to determine the effect of the Family Integrated Care (FICare) model on the readiness of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) for discharge and home care of the infants. STUDY DESIGN Parents in the intervention group received FICare, and parents in the control group received standard care. RESULTS The total mean score of the mothers and fathers in the intervention group regarding readiness for discharge and home care was higher than that of the control group, and a significant difference was observed. A statistically significant difference was found in terms of discharge weight, the day of first enteral feeding, and first breast milk. CONCLUSION The FICare model was observed to enhance the readiness of mothers and fathers for discharge and home care and positively affect the infant's weight gain, the status of breastfeeding and the continuation of nutrition. CLINICAL TRIAL REGISTRATION Registered on ClinicalTrials.gov (Identifiers: NCT04478162 Unique Protocol ID: 16214662/050.01.04/14) on 17/07/2020.
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Affiliation(s)
- Öznur Tiryaki
- Department of Midwifery, Faculty of Health Science, Sakarya University, Sakarya, Turkey.
| | - Nursan Çınar
- Department of Pediatric Nursing, Faculty of Health Science, Sakarya University, Sakarya, Turkey
| | - İbrahim Caner
- Faculty of Medicine, Division of Neonatology, Department of Pediatrics, Sakarya University, Sakarya, Turkey
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MCCONNELL MARGARET, AGARWAL SUMIT, HANSON ERIKA, MCCRADY ERIN, PARKER MARGARETG, BONA KIRA. Prescription for Cash? Cash Support to Low-Income Families in Maternal and Pediatric Health Care Settings. Milbank Q 2024; 102:64-82. [PMID: 37994263 PMCID: PMC10938935 DOI: 10.1111/1468-0009.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
Policy Points Pregnancy and childhood are periods of heightened economic vulnerability, but current policies for addressing health-related social needs, including screening and referral programs, may be insufficient because of persistent gaps, incomplete follow-up, administrative burden, and limited take-up. To bridge gaps in the social safety net, direct provision of cash transfers to low-income families experiencing health challenges during pregnancy, infancy, and early childhood could provide families with the flexibility and support to enable caregiving, increase access to health care, and improve health outcomes.
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Affiliation(s)
| | | | - ERIKA HANSON
- Center for Health Law and Policy Innovation, Harvard Law School
| | - ERIN MCCRADY
- Center for Health Law and Policy Innovation, Harvard Law School
| | - MARGARET G. PARKER
- Child Health Equity CenterUniversity of Massachusetts Chan Medical School
| | - KIRA BONA
- Harvard Medical School
- Dana‐Farber Cancer Institute
- Boston Children's Hospital
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Franco Fuenmayor ME, Fawcett A, Schwartz KE, Horner S, Balasundaram M, Burke BL, Bean KA, Russell LN, Simonton E, Machut KZ, Fry JT. Understanding family-centered care in the NICU: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00276. [PMID: 38385497 DOI: 10.11124/jbies-23-00252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This scoping review aims to identify and categorize the definitions of neonatal intensive care unit (NICU) family-centered care (FCC) and its associated concepts. It also aims to identify and categorize the practices and interventions that comprise NICU FCC, and catalog the metrics used to evaluate NICU FCC. INTRODUCTION FCC has been identified as an important element of care for neonates and infants admitted to the NICU, and there is clear evidence that the incorporation of families in care improves clinical outcomes. However, FCC has been linked to numerous associated terms and concepts and lacks a unifying definition or framework, thus limiting the ability to categorize, prioritize, and identify practices and interventions to optimize both institutional approaches for individual centers and for the field at large. INCLUSION CRITERIA Studies that include or apply at least one FCC concept or its associated terms will be considered eligible for inclusion. Studies not related exclusively to the NICU will be excluded. METHODS The review will follow the JBI methodology for scoping reviews and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Several electronic databases and sources of gray literature will be searched from 1992 to the present day. The review will include only full-text studies in English and will be independently screened by a minimum of 2 authors. Data will be extracted using a modified JBI data extraction tool and presented using narrative summaries; concept mapping; and categorization of practices, interventions, and metrics.
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Affiliation(s)
- Maria E Franco Fuenmayor
- Department of Pediatrics, Division of Neonatology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrea Fawcett
- Lurie Children's Pediatric Research and Evidence Synthesis Centre (PRECIISE): A JBI Affiliated Group, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Clinical and Organizational Development, Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine E Schwartz
- Division of Neonatal-Perinatal Medicine, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Susan Horner
- Lurie Children's Pediatric Research and Evidence Synthesis Centre (PRECIISE): A JBI Affiliated Group, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Malathi Balasundaram
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Barbara Lawlor Burke
- Patient Family Experience Department, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine A Bean
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Laura N Russell
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jessica T Fry
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Rodrigues SM, Bounds DT, Terry J, Pinto MD, Shin S, Burton CW. Application of Trauma-Informed Care Principles to Care Needs Identified by Mothers of NICU-Hospitalized Children. Issues Ment Health Nurs 2024; 45:142-151. [PMID: 37699105 DOI: 10.1080/01612840.2023.2250000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Systematic uptake of family-centered care (FCC) interventions remains challenging and frequently suboptimal in many neonatal intensive care units (NICUs). Across NICUs in the United States, integrating family members as partners in infant caregiving and decision-making has not been well supported and routine screening and provision of psychological support for parents remains inadequate. Trauma-informed care (TIC) may offer a more comprehensive approach to NICU care which can encompass FCC principles and promote family recovery and resilience by recognizing and responding to the traumas experienced by NICU infants and families. The current paper aimed to understand needs identified by mothers of NICU-hospitalized children and reports a focused analysis of one-on-one interview data (n = 13 mothers) collected during a larger mixed methods study. Reflexive thematic analysis was used to understand needs identified by mothers and to explore how these needs aligned with TIC principles. Six themes were identified and subsequently examined in the context of the principles of TIC: I Just Had No Control, That Really Caught Us Off Guard, So Much Was Already Taken Away, We're People and There Needs To Be More Support and Practices Which Helped. Mothers' care needs were found to align with TIC principles. Findings suggest that implementation of TIC principles in NICU settings can support parental presence, participation in infant care, and mental health and support the potential of TIC as a more comprehensive approach to meeting the needs of NICU parents.
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Affiliation(s)
- Sarah M Rodrigues
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Dawn T Bounds
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Jennifer Terry
- Department of Gender & Sexuality Studies, University of California, Irvine, California, USA
| | - Melissa D Pinto
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Sanghyuk Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
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Legge AA, Middleton JL, Reid S, Gordon A. Implementation of a Web Camera System in an Australian Neonatal Intensive Care Unit: Pre- and Postevaluation of the Parent and Staff Experience. JMIR Pediatr Parent 2023; 6:e47552. [PMID: 37997771 PMCID: PMC10690101 DOI: 10.2196/47552] [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: 04/11/2023] [Revised: 09/04/2023] [Accepted: 09/18/2023] [Indexed: 11/25/2023] Open
Abstract
Background Admission to a neonatal intensive care unit (NICU) for prematurity or illness is necessary for approximately 20% of newborns in Australia, resulting in parent-infant separation. Web cameras in the NICU provide a virtual link for parents to remain remotely connected to their infant during admission. Web camera use is increasing; however, there is limited evidence on the impact of web cameras on parents, infants, and neonatal staff. Objective There were two objectives: (1) to determine the attitudes of parents and staff toward web cameras in the NICU and (2) to compare parental depression, anxiety, and stress levels using validated scales before and after web camera implementation in the NICU. Methods A pre- and postevaluation survey was administered before and after implementation of the NICVIEW camera system in a tertiary NICU in Sydney, Australia. The NICVIEW camera system provides secure real-time viewing of infants and can be accessed from any device with an internet connection. Surveys were administered to parents of inpatients and staff, and included open- and closed-ended questions and Likert scales. Survey questions aimed to determine parent and staff attitudes and use of web cameras before and after implementation. In addition, pre- and postimplementation parental levels of depression, anxiety, and stress, as measured by the 21-item version of the Depression Anxiety Stress Scale (DASS-21) and Parental Stressor Scale: Neonatal Intensive Care Unit, were recorded. Results In total, 94 parents and 109 staff members completed the pre- and postimplementation surveys. Post implementation, 43 of 44 (98%) parents supported web cameras, and 40 of 42 (95%) parents stated that they used web cameras. The most common reasons for support from parents included web cameras making parents feel more at ease, facilitating parent-infant bonding, increasing parental confidence in staff, and allowing others to see infants. There was no significant difference between the parental groups for the depression, anxiety, or stress scales measured by DASS-21. Staff support for web cameras increased significantly from 34 of 42 (81%) participants before to 64 of 67 (96%) participants after implementation (P=.01). Following implementation, there was a resolution in staff concerns about web cameras having an adverse impact on staff roles and privacy and security concerns. Conclusions Web camera use in a tertiary Australian NICU was strongly supported by parents and staff and may reduce parental stress, facilitate parent-infant bonding, and encourage positive parent-staff engagement. Web cameras are a feasible method of providing continuity of care for families and should be considered as a standard of care in similarly resourced settings.
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Affiliation(s)
- Alexandra A Legge
- Department of Newborn Care, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Jennifer L Middleton
- Department of Newborn Care, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Shelley Reid
- Department of Newborn Care, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Adrienne Gordon
- Department of Newborn Care, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
- Sydney Institute of Women, Children and Families, Sydney Local Health District, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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McCarty DB, Dusing SC, Thorpe D, Weinberger M, Pusek S, Gilbert A, Liu T, Blazek K, Hammond S, O'Shea TM. A Feasibility Study of a Physical and Occupational Therapy-Led and Parent-Administered Program to Improve Parent Mental Health and Infant Development. Phys Occup Ther Pediatr 2023; 44:316-335. [PMID: 37867378 PMCID: PMC11018484 DOI: 10.1080/01942638.2023.2271102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
AIMS Extremely premature birth puts infants at high risk for developmental delay and results in parent anxiety and depression. The primary objective of this study was to characterize feasibility and acceptability of a therapist-led, parent-administered therapy and massage program designed to support parent mental health and infant development. METHODS A single cohort of 25 dyads - parents (24 mothers, 1 father) and extremely preterm (<28 wk gestation) infants - participated in the intervention. During hospitalization, parents attended weekly hands-on education sessions with a primary therapist. Parents received bi-weekly developmental support emails for 12 months post-discharge and were scheduled for 2 outpatient follow up visits. We collected measures of parent anxiety, depression, and competence at baseline, hospital discharge, and <4 and 12 months post-discharge. RESULTS All feasibility targets were met or exceeded at baseline and discharge (≥70%). Dyads participated in an average of 11 therapy sessions (range, 5-20) during hospitalization. Lower rates of data collection adherence were observed over successive follow ups (range, 40-76%). Parent-rated feasibility and acceptability scores were high at all time points. CONCLUSIONS Results support parent-rated feasibility and acceptability of the TEMPO intervention for extremely preterm infants and their parents in the Neonatal Intensive Care Unit.
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Affiliation(s)
- Dana B McCarty
- Department of Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Stacey C Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Deborah Thorpe
- Department of Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Morris Weinberger
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susan Pusek
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Alana Gilbert
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tianyi Liu
- Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kerry Blazek
- Department of Rehabilitation Services, University of North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - Sara Hammond
- Department of Rehabilitation Services, University of North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - T Michael O'Shea
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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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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12
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Zimmermann M, Julce C, Sarkar P, McNicholas E, Xu L, Carr C, Boudreaux ED, Lemon SC, Byatt N. Can psychological interventions prevent or reduce risk for perinatal anxiety disorders? A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 84:203-214. [PMID: 37619299 PMCID: PMC10569160 DOI: 10.1016/j.genhosppsych.2023.08.005] [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: 05/17/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Little is known about the extent to which interventions can prevent perinatal anxiety disorders. We conducted a systematic review and meta-analysis to examine whether interventions can decrease the onset and symptoms of perinatal anxiety among individuals without an anxiety disorder diagnosis. METHOD We conducted a comprehensive literature search across five databases related to key concepts: (1) anxiety disorders/anxiety symptom severity (2) perinatal (3) interventions (4) prevention. We included studies that examined a perinatal population without an anxiety disorder diagnosis, included a comparator group, and assessed perinatal anxiety. We included interventions focused on perinatal anxiety as well as interventions to prevent perinatal depression or influence related outcomes (e.g., physical activity). RESULTS Thirty-six studies were included. No study assessing the incidence of perinatal anxiety disorder (n = 4) found a significant effect of an intervention. Among studies assessing anxiety symptom severity and included in the quantitative analysis (n = 30), a meta-analysis suggested a small standardized mean difference of -0.31 (95% CI [-0.46, -0.16], p < .001) for anxiety at post intervention, favoring the intervention group. Both mindfulness (n = 6), and cognitive behavioral therapy approaches (n = 10) were effective. CONCLUSIONS Interventions developed for perinatal anxiety were more effective than interventions to prevent perinatal depression. Psychological interventions show promise for reducing perinatal anxiety symptom severity, though interventions specifically targeting anxiety are needed.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America.
| | - Clevanne Julce
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Pooja Sarkar
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Eileen McNicholas
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Lulu Xu
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Catherine Carr
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Edwin D Boudreaux
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
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13
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Franck LS, Gay CL, Hoffmann TJ, Kriz RM, Bisgaard R, Cormier DM, Joe P, Lothe B, Sun Y. Maternal mental health after infant discharge: a quasi-experimental clinical trial of family integrated care versus family-centered care for preterm infants in U.S. NICUs. BMC Pediatr 2023; 23:396. [PMID: 37563722 PMCID: PMC10413600 DOI: 10.1186/s12887-023-04211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Involvement in caregiving and tailored support services may reduce the risk of mental health symptoms for mothers after their preterm infant's neonatal intensive care unit (NICU) discharge. We aimed to compare Family-Centered Care (FCC) with mobile-enhanced Family-Integrated Care (mFICare) on post-discharge maternal mental health symptoms. METHOD This quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from three NICUs into sequential cohorts: FCC or mFICare. We analyzed post-discharge symptoms of perinatal post-traumatic stress disorder (PTSD) and depression using intention-to-treat and per protocol approaches. RESULTS 178 mothers (89 FCC; 89 mFICare) completed measures. We found no main effect of group assignment. We found an interaction between group and stress, indicating fewer PTSD and depression symptoms among mothers who had higher NICU-related stress and received mFICare, compared with mothers who had high stress and received FCC (PTSD: interaction β=-1.18, 95% CI: -2.10, -0.26; depression: interaction β=-0.76, 95% CI: -1.53, 0.006). Per protocol analyses of mFICare components suggested fewer PTSD and depression symptoms among mothers who had higher NICU stress scores and participated in clinical team rounds and/or group classes, compared with mothers who had high stress and did not participate in rounds or classes. CONCLUSION Overall, post-discharge maternal mental health symptoms did not differ between the mFICare and FCC groups. However, for mothers with high levels of stress during the NICU stay, mFICare was associated with fewer post-discharge PTSD and depression symptoms.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA.
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, Office of Research, School of Nursing, UCSF, San Francisco, CA, USA
| | - Rebecca M Kriz
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA
| | - Robin Bisgaard
- Intensive Care Nursery, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Diana M Cormier
- NICU and Pediatrics, Community Regional Medical Center, Fresno, CA, USA
| | - Priscilla Joe
- Division of Neonatology, UCSF Benioff Children's Hospital, Oakland, CA, USA
| | | | - Yao Sun
- Division of Neonatology, Department of Pediatrics, UCSF, San Francisco, CA, USA
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14
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Franck LS, Axelin A, Van Veenendaal NR, Bacchini F. Improving Neonatal Intensive Care Unit Quality and Safety with Family-Centered Care. Clin Perinatol 2023; 50:449-472. [PMID: 37201991 DOI: 10.1016/j.clp.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
There is strong evidence that family-centered care (FCC) improves the health and safety of infants and families in neonatal settings. In this review, we highlight the importance of common, evidence-based quality improvement (QI) methodology applied to FCC and the imperative to engage in partnership with neonatal intensive care unit (NICU) families. To further optimize NICU care, families should be included as essential team members in all NICU QI activities, not only FCC QI activities. Recommendations are provided for building inclusive FCC QI teams, assessing FCC, creating culture change, supporting health-care practitioners and working with parent-led organizations.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco, 2 Koret Way, N411F, Box 0606, San Francisco, CA 94143, USA.
| | - Anna Axelin
- Department of Nursing Science, University of Turku, 20014 University of Turku, Finland. https://twitter.com/AnnaAxelin
| | - Nicole R Van Veenendaal
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands. https://twitter.com/nicolevan_vee
| | - Fabiana Bacchini
- Canadian Premature Babies Foundation, 4225-B Dundas Street West, Etobicoke, ON M8X 1Y3, Canada. https://twitter.com/fabianabacchini
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15
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Gong J, Fellmeth G, Quigley MA, Gale C, Stein A, Alderdice F, Harrison S. Prevalence and risk factors for postnatal mental health problems in mothers of infants admitted to neonatal care: analysis of two population-based surveys in England. BMC Pregnancy Childbirth 2023; 23:370. [PMID: 37217846 PMCID: PMC10201804 DOI: 10.1186/s12884-023-05684-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Previous research suggests that mothers whose infants are admitted to neonatal units (NNU) experience higher rates of mental health problems compared to the general perinatal population. This study examined the prevalence and factors associated with postnatal depression, anxiety, post-traumatic stress (PTS), and comorbidity of these mental health problems for mothers of infants admitted to NNU, six months after childbirth. METHODS This was a secondary analysis of two cross-sectional, population-based National Maternity Surveys in England in 2018 and 2020. Postnatal depression, anxiety, and PTS were assessed using standardised measures. Associations between sociodemographic, pregnancy- and birth-related factors and postnatal depression, anxiety, PTS, and comorbidity of these mental health problems were explored using modified Poisson regression and multinomial logistic regression. RESULTS Eight thousand five hundred thirty-nine women were included in the analysis, of whom 935 were mothers of infants admitted to NNU. Prevalence of postnatal mental health problems among mothers of infants admitted to NNU was 23.7% (95%CI: 20.6-27.2) for depression, 16.0% (95%CI: 13.4-19.0) for anxiety, 14.6% (95%CI: 12.2-17.5) for PTS, 8.2% (95%CI: 6.5-10.3) for two comorbid mental health problems, and 7.5% (95%CI: 5.7-10.0) for three comorbid mental health problems six months after giving birth. These rates were consistently higher compared to mothers whose infants were not admitted to NNU (19.3% (95%CI: 18.3-20.4) for depression, 14.0% (95%CI: 13.1-15.0) for anxiety, 10.3% (95%CI: 9.5-11.1) for PTS, 8.5% (95%CI: 7.8-9.3) for two comorbid mental health problems, and 4.2% (95%CI: 3.6-4.8) for three comorbid mental health problems six months after giving birth. Among mothers of infants admitted to NNU (N = 935), the strongest risk factors for mental health problems were having a long-term mental health problem and antenatal anxiety, while social support and satisfaction with birth were protective. CONCLUSIONS Prevalence of postnatal mental health problems was higher in mothers of infants admitted to NNU, compared to mothers of infants not admitted to NNU six months after giving birth. Experiencing previous mental health problems increased the risk of postnatal depression, anxiety, and PTS whereas social support and satisfaction with birth were protective. The findings highlight the importance of routine and repeated mental health assessments and ongoing support for mothers of infants admitted to NNU.
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Affiliation(s)
- Jenny Gong
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - Gracia Fellmeth
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - Maria A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster Campus, 369 Fulham Road, London, UK
| | - Alan Stein
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Siân Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK.
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Campbell-Yeo M, Dol J, McCulloch H, Hughes B, Hundert A, Bacchini F, Whitehead L, Afifi J, Alcock L, Bishop T, Dorling J, Earle R, Elliott Rose A, Inglis D, Leighton C, MacRae G, Melanson A, Simpson CD, Smit M. The Impact of Parental Presence Restrictions on Canadian Parents in the NICU During COVID-19: A National Survey. JOURNAL OF FAMILY NURSING 2023; 29:18-27. [PMID: 35915967 PMCID: PMC9850074 DOI: 10.1177/10748407221114326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The purpose of this research was to explore parental perspectives on the impact of parent restrictions imposed in response to the COVID-19 pandemic across Canadian Neonatal Intensive Care Units (NICUs). A co-designed online survey was conducted targeting parents (n = 235) of infants admitted to a Canadian NICU from March 1, 2020, until March 5, 2021. Parents completed the survey from 38 Canadian NICUs. Large variation in the severity of policies regarding parental presence was reported. Most respondents (68.9%) were classified as experiencing high restrictions, with one or no support people allowed in the NICU, and felt that policies were less easy to understand, felt less valued and respected, and found it more challenging to access medicine or health care. Parents reported gaps in care related to self-care, accessibility, and mental health outcomes. There is significant variation in parental restrictions implemented across Canadian NICUs. National guidelines are needed to support consistent and equitable care practices.
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Affiliation(s)
| | | | | | | | | | | | | | - Jehier Afifi
- Dalhousie University, Halifax, NS,
Canada
- IWK Health, Halifax, NS, Canada
| | | | | | - Jon Dorling
- University Hospital Southampton NHS
Foundation Trust, Southampton, UK
| | | | | | | | | | | | | | - C. David Simpson
- Dalhousie University, Halifax, NS,
Canada
- IWK Health, Halifax, NS, Canada
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17
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Franck LS, Kriz RM, Bisgaard R, Gay CL, Sossaman S, Sossaman J, Cormier DM, Joe P, Sasinski JK, Kim JH, Lin C, Sun Y. Parent Readiness for Their Preterm Infant's Neonatal Intensive Care Unit Discharge. J Perinat Neonatal Nurs 2023; 37:68-76. [PMID: 36707751 DOI: 10.1097/jpn.0000000000000612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study aims to examine the influence of hospital experience factors on parental discharge readiness, accounting for key background characteristics. Parents/guardians of infants 33 weeks of gestation or less at birth receiving neonatal intensive care at 6 sites were enrolled from April 2017 to August 2018. Participants completed surveys at enrollment, 3 weeks later, and at discharge. Multiple regression analysis assessed relationships between parental experience, well-being, and perceived readiness for infant discharge, adjusting for socioenvironmental, infant clinical, and parent demographic characteristics. Most (77%) of the 139 parents reported high levels of readiness for their infant's discharge and 92% reported high self-efficacy at discharge. The multiple regression model accounted for 40% of the variance in discharge readiness. Perceptions of family-centered care accounted for 12% of the variance; measures of parent well-being, anxiety, and parenting self-efficacy accounted for an additional 16% of the variance; parent characteristics accounted for an additional 9%; and infant characteristics accounted for less than 3% of the variance. Parental perceptions of the family-centeredness of the hospital experience, anxiety, and parenting self-efficacy accounted for a substantial proportion of the variance in readiness for discharge scores among parents of preterm infant. These influential perceptions are potentially modifiable by nursing-led interventions.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing and the California Preterm Birth Initiative, University of California, San Francisco, San Francisco (Drs Franck and Gay and Ms Kriz); Intensive Care Nursery (Mss Bisgaard and S. Sossaman and Mr J. Sossaman) and Division of Neonatology (Dr Sun), UCSF Benioff Children's Hospital, San Francisco, California; Neonatal and Pediatrics, Community Regional Medical Center, Fresno, California (Dr Cormier); Division of Neonatology, UCSF Benioff Children's Hospital, Oakland, California (Dr Joe); Intensive Care Nursery, Santa Monica Medical Center, UCLA Health, Santa Monica, California (Ms Sasinski); Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Kim); and Division of Neonatology, Kaiser Permanente, Santa Clara, California (Dr Lin)
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18
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Paula LDS, Celli A, Mariotto RMM, Lagos-Guimarães HNC, Marciniak A. Frequency of maternal stress and psychic risk in newborns who have been hospitalized in a neonatal intensive care unit. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200040004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abstract Objectives: describe the frequency of maternal stress and psychic risk indicators in newborns who were exposed to the neonatal intensive care unit (NICU) after hospital discharge. Methods: observational, analytical, cohort study, sample of 26 participants (13 exposed and 13 not exposed to the NICU). Maternal stress was assessed by Inventário de Sintomas de Stress para Adultos de Lipp (ISSL) (Lipp’s Stress Symptoms Inventory for Adults) and psychological risk by Indicadores Clínicos de Risco para o Desenvolvimento Infantil (IRDI) (Clinical Risk Indicators for Child Development), 15 days after hospital discharge and at 4 months of corrected age. Results: the study found a frequency of stress of 23.1% in mothers of newborns who were exposed to NICUs and 38.5% of psychological risk in these newborns. The following associations were found: maternal stress and newborn exposure to the NICU (p=0.037); maternal stress and newborn exposure time to NICU (p=0.031); psychological risk and prematurity (p=0.014). There were no association between psychic risk and maternal stress; and there was no diference in the frequency of psychological risk between the groups of newborns. Conclusions: newborn hospitalization in the NICU is associated with maternal stress, but not with psychological risk. Prematurity can cause psychological risk. Maternal stress was not associated with psychological risk.
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van Veenendaal NR, Labrie NH, Mader S, van Kempen AAMW, van der Schoor SRD, van Goudoever JB, Bertino E, Bhojnagarwala B, Bodrogi E, Bohlin K, Bracht M, Bührer C, Domellöf M, Embleton N, Endl C, Ertl T, Funke S, Gangi S, Garg S, Guimarães H, Haiden N, Koskinen E, Klingenberg C, Klisch O, Kobberup H, Kovalova OM, Krolak‐Olejnik B, Lapillonne A, Lee S, Lehtonen L, McKechnie L, Mimoso G, Molloy E, Moltu SJ, Mulder AL, Nádor C, Normann E, O'Brien K, Van Overmeire B, Pavlyshyn H, Pellicer A, Picaud J, Poets CF, Rabe H, Ryan E, Sadowska‐Krawczenko I, Salvesen B, Sanakova P, Sarapuk I, Schuler R, Senterre T, Strola P, Thomas M, Vento M, Voloshko V, Weis J, Wiedermannová H, Zabakas K. An international study on implementation and facilitators and barriers for parent‐infant closeness in neonatal units. Pediatr Investig 2022; 6:179-188. [PMID: 36203512 PMCID: PMC9523817 DOI: 10.1002/ped4.12339] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/31/2022] [Indexed: 11/11/2022] Open
Abstract
Importance Parent‐infant closeness and active parent participation in neonatal care are important for parent and infant health. Objective To give an overview of current neonatal settings and gain an in‐depth understanding of facilitators and barriers to parent‐infant closeness, zero‐separation, in 19 countries. Methods Neonatal intensive care unit (NICU) professionals, representing 45 NICUs from a range of geographic regions in Europe and Canada, were purposefully selected and interviewed June–December 2018. Thematic analysis was conducted to identify, analyze and report patterns (themes) for parent‐infant closeness across the entire series of interviews. Results Parent‐infant separation during infant and/or maternity care is very common (42/45 units, 93%), despite the implementation of family integrated care (FICare) practices, including parent participation in medical rounds (17/45, 38%), structured education sessions for parents (16/45, 36%) and structured training for healthcare professionals (22/45, 49%). NICU professionals encountered four main themes with facilitators and barriers for parent‐infant closeness on and between the hospital, unit, staff, and family level: Culture (jointly held characteristics, values, thinking and behaviors about parental presence and participation in the unit), Collaboration (the act of working together between and within different levels), Capacities (resources and policies), and Coaching (education to acquire and transfer knowledge and skills). Interpretation Implementing parent‐infant closeness in the NICU is still challenging for healthcare professionals. Further optimization in neonatal care towards zero‐separation and parent‐infant closeness can be achieved by enforcing the ‘four Cs for Closeness’: Culture, Collaboration, Capacities, and Coaching.
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Affiliation(s)
- Nicole R. van Veenendaal
- Department of Pediatrics and Neonatology OLVG Amsterdam The Netherlands
- Amsterdam UMC, location Vrije Universiteit and location University of Amsterdam Department of Pediatrics, Emma Children's Hospital Amsterdam The Netherlands
| | - Nanon H.M. Labrie
- Department of Pediatrics and Neonatology OLVG Amsterdam The Netherlands
- Department of Language, Literature and Communication Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Silke Mader
- European Foundation for Care of Newborn Infants Munich Germany
| | | | | | - Johannes B. van Goudoever
- Amsterdam UMC, location Vrije Universiteit and location University of Amsterdam Department of Pediatrics, Emma Children's Hospital Amsterdam The Netherlands
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20
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Pavlyshyn Н, Sarapuk I, Saturska U. Maternal Stress Experience in the Neonatal Intensive Care Unit after Preterm Delivery. Am J Perinatol 2022. [PMID: 36029767 DOI: 10.1055/s-0042-1747942] [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: 11/01/2022]
Abstract
OBJECTIVE Preterm delivery with the admission of a child in the neonatal intensive care unit (NICU) is extremely challenging for parents. Being separated from the baby and seeing her infant feeling pain and being sick together with the complexity of the NICU environment, the mother experiences great anxiety, fear, and stress. The purpose of the study was to assess NICU-related stress and to identify maternal and infant factors associated with increased stress in mothers of preterm infants. STUDY DESIGN The maternal stress level was assessed in 122 mothers of preterm infants using the Parental Stressor Scale: NICU (PSS: NICU) in which items were distributed in three subscales as follows: Sights and Sounds of NICU-subscale 1 (S1), Infant Appearance and Behavior-S2, and Parental Role Alteration-S3. RESULTS Maternal total PSS: NICU score was 3.46 ± 0.71. Parenteral Role Alteration was the most stressful (4.20 ± 0.79) followed by Infant Appearance and Behavior (3.51 ± 0.91) and Sights and Sounds subscale (2.28 ± 0.95); p (S1-S2) < 0.001, p (S1-S3) < 0.001, and p (S2-S3) < 0.001. Total PSS: NICU and Infant Appearance and Behavior scores correlated positively with maternal age (r = 0.189; p = 0.040 and r = 0.204; p = 0.027, respectively) and duration of NICU treatment (r = 0.188; p = 0.044 and r = 0.190; p = 0.042). More visits in NICU by a mother were associated with a lower PSS: NICU score (p = 0.049) and neonatal seizures and invasive ventilation in infants were associated with higher stress scores (p = 0.007 and p = 0.042). CONCLUSION Mothers of preterm infants admitted in the NICU experience significant stress which is correlated with maternal age and NICU treatment duration and is associated with frequency of NICU visits, presence of neonatal seizures, and need for ventilator support. Parental role alteration is the greatest stressor followed by Infant Appearance and Behavior and NICU-surrounding stressor factors which show the need for interventions and counseling focused on mothers' role, their involvement in infant's care, and thus, family-centered care implementation. KEY POINTS · Mothers of preterm infants experience significant stress.. · Parental role alteration is the greatest maternal stressor.. · Maternal stress is correlated with age and NICU duration, and is associated with the frequency of NICU visits and infant's health status.
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Affiliation(s)
- Нalyna Pavlyshyn
- Department of Pediatrics No 2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Iryna Sarapuk
- Department of Pediatrics No 2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Uliana Saturska
- Department of Pediatrics No 2, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Levene I, Bell JL, Cole C, Stanbury K, O'Brien F, Fewtrell M, Quigley MA. Comparing the effect of a lactation-specific relaxation and visualisation intervention versus standard care on lactation and mental health outcomes in mothers of very premature infants (the EXPRESS trial): study protocol for a multi-centre, unmasked, randomised, parallel-group trial. Trials 2022; 23:611. [PMID: 35906655 PMCID: PMC9335469 DOI: 10.1186/s13063-022-06570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Premature birth is the leading cause of neonatal death and can cause major morbidity. Maximising the amount of maternal breastmilk given to very premature infants is important to improve outcomes, but this can be challenging for parents. Parents of infants receiving neonatal care also have high rates of anxiety and distress. There is growing evidence for the impact of maternal relaxation interventions on lactation, as well as mental health. The trial will assess whether a brief self-directed relaxation and visualisation intervention, recommended for use several times a day during expression of milk, improves lactation and mental health outcomes for mothers of very premature infants. Methods Multi-centre, randomised, controlled, unmasked, parallel-group trial with planned 132 participants who have experienced premature birth between 23 weeks and 31 weeks and 6 days of gestation and plan to express milk for at least 14 days. The primary outcome is the highest 24-h expressed milk yield recorded on any of day 4, day 14 or day 21 after birth. Secondary outcomes include exclusive breastmilk feeding at 36 weeks post-menstrual age and at 4 months after the estimated date of delivery, Spielberger State Trait Anxiety Index at day 21 and Post-traumatic stress Check List (for DSM 5) at day 21. Discussion Breastmilk feeding for premature infants is an important research priority, but there are few randomised controlled trials assessing interventions to help parents reach lactation goals in this challenging context. This trial will assess whether a no cost, easily scalable relaxation tool has a role in this setting. Given the lack of harm and potential for immediate dissemination, even a small benefit could have an important global impact. Trial registration ISRCTN16356650. Date assigned: 19/04/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06570-9.
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Affiliation(s)
- Ilana Levene
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer L Bell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christina Cole
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kayleigh Stanbury
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Frances O'Brien
- Newborn Care, John Radcliffe Hospital, Oxford University Hospitals NHS Trust & Faculty of Clinical Medicine, University of Oxford, Oxford, UK
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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22
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Ruhe K, van den Hoogen A, Bröring‐Starre T, Wielenga JM, van Weissenbruch MM. Getting a grip in the middle of chaos: Preparing for preterm parenthood during a high-risk pregnancy - Parental experiences and needs. Acta Paediatr 2022; 111:1324-1330. [PMID: 35429200 PMCID: PMC9321692 DOI: 10.1111/apa.16361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 12/05/2022]
Abstract
Aim Admitting an infant to a neonatal intensive care unit (NICU) is stressful for parents. A great source of stress is the loss of their desired parental role. This study explores parents’ experiences and needs during a high‐risk pregnancy in preparation for their role as parents of a preterm infant. Methods An exploratory qualitative study was conducted among parents with a preterm infant admitted to two level‐III NICUs in the Netherlands. A thematic analysis was performed. Results Nineteen interviews were conducted with parents of preterm infants (26–34 weeks gestational age). Getting a grip in the middle of chaos was identified as the central theme. In the pre‐admission phase, coping with potential preterm parenthood was a theme, with coping strategies as subthemes that changed over time from avoidance to being ready to parent a preterm infant. The theme envisioning the NICU emerged in the NICU admission phase, with subthemes preterm care journey and opportunities for involvement fostering parental empowerment. Conclusion Timing and content of information about a parental role in the NICU should be tailored to the individual expectant parent. A customisable intervention bundle may provide a vision of the NICU and the parents’ active role in care.
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Affiliation(s)
- Kiki Ruhe
- Department of Neonatology Amsterdam University Medical Centers, location VUmc Amsterdam The Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology Wilhelmina Children’s Hospital University Medical Center Utrecht Utrecht The Netherlands
| | - Tinka Bröring‐Starre
- Department of Child Psychiatry and Psychosocial Care Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Joke M. Wielenga
- Department of Neonatology Emma Children's Hospital Amsterdam University Medical Centers, AMC Amsterdam The Netherlands
| | - Mirjam M. van Weissenbruch
- Department of Neonatology Amsterdam University Medical Centers, location VUmc Amsterdam The Netherlands
- Department of Neonatology Amsterdam University Medical Centers Vrije Universiteit Amsterdam The Netherlands
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23
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Liang X, Miao A, Zhang W, Li M, Xing Y. Effect of family integrated care on physical growth and language development of premature infants: a retrospective study. Transl Pediatr 2022; 11:965-977. [PMID: 35800279 PMCID: PMC9253945 DOI: 10.21037/tp-22-210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/27/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Premature birth (PTB) increases the long-term risk of diseases such as hypertension, heart disease, and diabetes in adulthood. It is an independent disease with the largest global burden in terms of high mortality and lifelong negative health impacts. The purpose of this study was to analyze the physical growth and language development of premature infants (PIs) at the age of 18 months, and to explore the impact of family integrated care (FIcare) on PI. METHODS This study retrospectively included mothers and their PIs born in the Neonatal Pediatrics Department, Affiliated Hospital of Nantong University from January 2018 to September 2020 and hospitalized in the neonatal intensive care unit (NICU) within 24 hours after birth. The weight, head circumference, body length, and language development of each child were followed up at the age of 1, 3, 6, 12, and 18 months and recorded, and the relationship between FIcare and physical growth and language development of PIs was evaluated. RESULTS The development quotient (DQ) score and language development score of the FIcare group were always higher than those of the control group from 6 to 18 months, and the difference was statistically significant (P<0.05). Multiple regression analysis showed that the body length of the FIcare group participants was longer than that of control group participants. The head circumference of infants was positively correlated with gestational age, birth head circumference, and family average monthly income. The head circumference of FIcare group participants was longer than that of control group participants. The DQ score was positively correlated with gestational age, and the FIcare group participants scored higher than control group participants. Logistic regression analysis showed that early language milestone (ELM) scale score and gestational age were positively correlated with mother's education, and the score of FIcare group participants was higher than that of control group participants (P<0.05). CONCLUSIONS Compared with the traditional nursing model, the implementation of FIcare for the hospitalized PIs in the NICU can actively promote the physical growth and language development of infants.
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Affiliation(s)
- Xiangyan Liang
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Aimei Miao
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Wei Zhang
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Min Li
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Yan Xing
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
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24
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Mclean MA, Scoten OC, Yu W, Ye XY, Petrie J, Church PT, Soraisham AS, Mirea LS, Weinberg J, Synnes AR, O'Brien K, Grunau RE. Lower Maternal Chronic Physiological Stress and Better Child Behavior at 18 Months: Follow-Up of a Cluster Randomized Trial of Neonatal Intensive Care Unit Family Integrated Care. J Pediatr 2022; 243:107-115.e4. [PMID: 34971651 DOI: 10.1016/j.jpeds.2021.12.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess whether Family Integrated Care (FICare) in the neonatal intensive care unit improves maternal chronic physiological stress and child behavior at 18 months of corrected age for infants born preterm. STUDY DESIGN Follow-up of a multicenter, prospective cluster-randomized controlled trial comparing FICare and standard care of children born at <33 weeks of gestation and parents, stratified by tertiary neonatal intensive care units, across Canada. Primary outcomes at 18 months of corrected age were maternal stress hormones (cortisol, ie, hair cumulative cortisol [HCC], dehydroepiandrosterone [DHEA]) assayed from hair samples. Secondary outcomes included maternal reports of parenting stress, child behaviors (Internalizing, Externalizing, Dysregulation), and observer-rated caregiving behaviors. Outcomes were analyzed using multilevel modeling. RESULTS We included 126 mother-child dyads from 12 sites (6 FICare sites, n = 83; 6 standard care sites, n = 43). FICare intervention significantly lowered maternal physiological stress as indicated by HCC (B = -0.22 [-0.41, -0.04]) and cortisol/DHEA ratio (B = -0.25 [-0.48, -0.02]), but not DHEA (B = 0.01 [-0.11, 0.14]). Enrollment in FICare led to lower child Internalizing (B = -0.93 [-2.33, 0.02]) and Externalizing behavior T scores (B = -0.91 [-2.25, -0.01]) via improvements to maternal HCC (mediation). FICare buffered the negative effects of high maternal HCC on child Dysregulation T scores (B = -11.40 [-23.01, 0.21]; moderation). For mothers reporting high parenting stress at 18 months, FICare was related to lower Dysregulation T scores via maternal HCC; moderated mediation = -0.17 (-0.41, -0.01). CONCLUSIONS FICare has long-term beneficial effects for mother and child, attenuating maternal chronic physiological stress, and improving child behavior in toddlerhood. CLINICAL TRIAL REGISTRATION NCT01852695.
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Affiliation(s)
- Mia A Mclean
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Olivia C Scoten
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Wayne Yu
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Julie Petrie
- BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Paige T Church
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne R Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Karel O'Brien
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; BC Women's Hospital, Vancouver, British Columbia, Canada.
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25
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van Veenendaal NR, van der Schoor SRD, Broekman BFP, de Groof F, van Laerhoven H, van den Heuvel MEN, Rijnhart JJM, van Goudoever JHB, van Kempen AAMW. Association of a Family Integrated Care Model With Paternal Mental Health Outcomes During Neonatal Hospitalization. JAMA Netw Open 2022; 5:e2144720. [PMID: 35072721 PMCID: PMC8787602 DOI: 10.1001/jamanetworkopen.2021.44720] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE During newborn hospitalization in the neonatal unit, fathers often feel anxious and excluded from their child's caregiving and decision-making. Few studies and interventions have focused on fathers' mental health and their participation in neonatal care. OBJECTIVE To study the association of a family integrated care (FICare) model (in single family rooms with complete couplet-care for the mother-newborn dyad) vs standard neonatal care (SNC) in open bay units with separate maternity care with mental health outcomes in fathers at hospital discharge of their preterm newborn and to study whether parent participation was a mediator of the association of the FICare model on outcomes. DESIGN, SETTING, AND PARTICIPANTS This prospective, multicenter cohort study was conducted from May 2017 to January 2020 as part of the fAMily Integrated Care in the Neonatal Ward Study, at level-2 neonatal units in the Netherlands (1 using the FICare model and 2 control sites using SNC). Participants included fathers of preterm newborns admitted to participating units. Data analysis was performed from January to April 2021. EXPOSURE FICare model in single family rooms with complete couplet-care for the mother-newborn dyad during maternity and/or neonatal care. MAIN OUTCOMES AND MEASURES Paternal mental health was measured using the Parental Stress Scale: NICU, Hospital Anxiety and Depression Scale, Post-partum Bonding Questionnaire, Perceived (Maternal) Parenting Self-efficacy Scale, and satisfaction with care (EMpowerment of PArents in THe Intensive Care-Neonatology). Parent participation (CO-PARTNER tool) was assessed as a potential mediator of the association of the FICare model with outcomes with mediation analyses (prespecified). RESULTS Of 309 families included in the fAMily Integrated Care in the Neonatal Ward Study, 263 fathers (85%) agreed to participate; 126 fathers were enrolled in FICare and 137 were enrolled in SNC. In FICare, 89 fathers (71%; mean [SD] age, 35.1 [4.8] years) responded to questionnaires and were analyzed. In SNC, 93 fathers (68%; mean [SD] age, 36.4 [5.5] years) responded to questionnaires and were analyzed. Fathers in FICare experienced less stress (adjusted β, -10.02; 95% CI, -15.91 to -4.13; P = .001) and had higher participation scores (adjusted odds ratio, 3.424; 95% CI, 0.860 to 5.988; P = .009) compared with those in SNC. Participation mediated the beneficial association of the FICare model with fathers' depressive symptoms (indirect effect, -0.051; 95% CI, -0.133 to -0.003) and bonding with their newborns (indirect effect, -0.082; 95% CI, -0.177 to -0.015). CONCLUSIONS AND RELEVANCE These findings suggest that the FICare model is associated with decreased paternal stress at discharge and enables fathers to be present and participate more than SNC, thus improving paternal mental health. Supporting fathers to actively participate in all aspects of newborn care should be encouraged regardless of architectural design of the neonatal unit.
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Affiliation(s)
- Nicole R. van Veenendaal
- Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands
- Emma Children’s Hospital, Amsterdam University Medical Centres, University of Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Birit F. P. Broekman
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
| | - Femke de Groof
- Department of Pediatrics and Neonatology, NoordWest ZiekenhuisGroep, Alkmaar, the Netherlands
| | | | | | - Judith J. M. Rijnhart
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
| | - J. Hans B. van Goudoever
- Emma Children’s Hospital, Amsterdam University Medical Centres, University of Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
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26
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Franck LS, Shellhaas RA, Lemmon ME, Sturza J, Barnes M, Brogi T, Hill E, Moline K, Soul JS, Chang T, Wusthoff CJ, Chu CJ, Massey SL, Abend NS, Thomas C, Rogers EE, McCulloch CE, Glass HC. Parent Mental Health and Family Coping over Two Years after the Birth of a Child with Acute Neonatal Seizures. CHILDREN 2021; 9:children9010002. [PMID: 35053627 PMCID: PMC8774381 DOI: 10.3390/children9010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
Little is known about parent and family well-being after acute neonatal seizures. In thus study, we aimed to characterize parent mental health and family coping over the first two years after their child’s neonatal seizures. Parents of 303 children with acute neonatal seizures from nine pediatric hospitals completed surveys at discharge and 12-, 18- and 24-months corrected age. Outcomes included parental anxiety, depression, quality of life, impact on the family, post-traumatic stress and post-traumatic growth. We used linear mixed effect regression models and multivariate analysis to examine relationships among predictors and outcomes. At the two-year timepoint, parents reported clinically significant anxiety (31.5%), depression (11.7%) and post-traumatic stress (23.7%). Parents reported moderately high quality of life and positive personal change over time despite ongoing challenges to family coping. Families of children with longer neonatal hospitalization, functional impairment, post-neonatal epilepsy, receiving developmental support services and families of color reported poorer parental mental health and family coping. Parents of color were more likely to report symptoms of post-traumatic stress and positive personal change. Clinicians caring for children with neonatal seizures should be aware of lasting risks to parent mental health and family coping. Universal screening would enable timely referral for support services to mitigate further risk to family well-being and child development.
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Affiliation(s)
- Linda S. Franck
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA 94143, USA;
- Correspondence:
| | - Renée A. Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA; (R.A.S.); (J.S.); (E.H.)
| | - Monica E. Lemmon
- Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Julie Sturza
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA; (R.A.S.); (J.S.); (E.H.)
| | | | - Trisha Brogi
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Elizabeth Hill
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA; (R.A.S.); (J.S.); (E.H.)
| | | | - Janet S. Soul
- Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA;
| | - Taeun Chang
- Department of Neurology, Children’s National Hospital, Washington, DC 20010, USA;
- Department of Neurology, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
| | - Courtney J. Wusthoff
- Departments of Neurology and Pediatrics, Stanford University, Palo Alto, CA 94304, USA;
| | - Catherine J. Chu
- Harvard Medical School, Boston, MA 02115, USA;
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Shavonne L. Massey
- Departments of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (S.L.M.); (N.S.A.)
- Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nicholas S. Abend
- Departments of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (S.L.M.); (N.S.A.)
- Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cameron Thomas
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Elizabeth E. Rogers
- Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Hannah C. Glass
- Departments of Neurology, Pediatrics, Epidemiology and Biostatistics, Weill Institute for Neuroscience, UCSF Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA 94143, USA;
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McCulloch H, Campbell-Yeo M, Richardson B, Dol J, Hundert A, Dorling J, Whitehead L, MacRae G, Bishop T, Afifi J, Earle R, Rose AE, Foye S, Inglis D, Kim T, Leighton C, Melanson A, Simpson DC, Smit M. The Impact of Restrictive Family Presence Policies in Response to COVID-19 on Family Integrated Care in the NICU: A Qualitative Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:49-62. [PMID: 34931565 PMCID: PMC9072949 DOI: 10.1177/19375867211065178] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: To conduct a needs assessment with families and their healthcare team to understand the impact of restrictive family presence policies in the neonatal intensive care unit (NICU) in response to COVID-19. Background: In response to the COVID-19 pandemic, significant restrictive family presence policies were instituted in most NICUs globally intended to protect infants, families, and HCPs. However, knowledge on the impact of the stress of the pandemic and policies restricting family presence in the NICU on vulnerable neonates and their families remains limited. Methods: Individuals were eligible to participate if they were a caregiver of an infant requiring NICU care or a healthcare provider (HCP) in the NICU after March 1, 2020. Semi-structured interviews were conducted using a virtual communication platform, and transcripts were analyzed using inductive thematic qualitative content analysis. Results: Twenty-three participants were interviewed (12 families and 11 HCPs). Three themes emerged: (1) successes (family-integrated care, use of technology), (2) challenges (lack of standardized messaging and family engagement, impact on parental wellbeing, institutional barriers, and virtual care), and (3) moving forward (responsive and supportive leadership). Conclusions: Our findings highlight the significant impact of family restrictions on the mental well-being of families, physical closeness with parents, and empathetic stress to HCPs. Further study of potential long-term impact is warranted.
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Affiliation(s)
| | - Marsha Campbell-Yeo
- IWK Health, Halifax, Nova Scotia, Canada.,Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brianna Richardson
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Justine Dol
- IWK Health, Halifax, Nova Scotia, Canada.,Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | | | | | | | - Sarah Foye
- IWK Health, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Mike Smit
- School of Information Management, Dalhousie University, Halifax, Nova Scotia, Canada
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28
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Campbell-Yeo M, Dol J, Richardson B, McCulloch H, Hundert A, Foye S, Dorling J, Afifi J, Bishop T, Earle R, Elliott Rose A, Inglis D, Kim T, Leighton C, MacRae G, Melanson A, Simpson DC, Smit M, Whitehead L. A co-design of clinical virtual care pathways to engage and support families requiring neonatal intensive care in response to the COVID-19 pandemic (COVES study). JOURNAL OF NEONATAL NURSING : JNN 2021; 27:463-470. [PMID: 34220279 PMCID: PMC8233852 DOI: 10.1016/j.jnn.2021.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/20/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND In response to the COVID-19 pandemic, family presence restrictions in neonatal intensive care units (NICU) were enacted to limit disease transmission. This has resulted in communication challenges, negatively impacting family integrated care. AIM To develop clinical care pathways to ensure optimal neonatal care to support families in response to parental presence restrictions imposed during the COVID-19 pandemic. METHODS An agile, co-design process utilizing expert consensus of a large interdisciplinary team and focus groups and semi-structured interviews with families and HCPs were used to co-design clinical virtual care pathways. RESULTS Three clinical virtual care pathways were co-designed: (1) building and maintaining relationships between family and healthcare providers; (2) awareness of resources; and (3) standardized COVID-19 messaging. Modifications were made to optimize uptake and utilization in the clinical areas. CONCLUSION Clinical care virtual pathways were successfully co-designed to meet these needs to ensure more equitable family centered care.
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Affiliation(s)
- Marsha Campbell-Yeo
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada,Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada,Department of Pediatrics, IWK Health & Dalhousie University, Halifax, Nova Scotia, Canada,Centre for Pediatric Pain Research, IWK Health, Halifax, Nova Scotia, Canada,IWK Health, Halifax, Nova Scotia, Canada,Corresponding author. School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada,Centre for Pediatric Pain Research, IWK Health, Halifax, Nova Scotia, Canada
| | - Brianna Richardson
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada,Centre for Pediatric Pain Research, IWK Health, Halifax, Nova Scotia, Canada
| | - Holly McCulloch
- Centre for Pediatric Pain Research, IWK Health, Halifax, Nova Scotia, Canada
| | - Amos Hundert
- Centre for Pediatric Pain Research, IWK Health, Halifax, Nova Scotia, Canada
| | - Sarah Foye
- Centre for Pediatric Pain Research, IWK Health, Halifax, Nova Scotia, Canada
| | - Jon Dorling
- Department of Pediatrics, IWK Health & Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jehier Afifi
- Department of Pediatrics, IWK Health & Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Carye Leighton
- Parent Partner, Neonatal Intensive Care Unit, IWK Health, Halifax, Nova Scotia, Canada
| | | | | | - David C. Simpson
- Department of Pediatrics, IWK Health & Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Smit
- School of Information Management, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Whitehead
- Parent Partner, Neonatal Intensive Care Unit, IWK Health, Halifax, Nova Scotia, Canada
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29
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Campbell-Yeo M, Kim T, Disher T, Richardson B, Dol J, Bishop T, Delahunty-Pike A, Dorling J, Glover M, Inglis D, Johnson T, Macmillan D, Mcgrath P, Monaghan J, Orovec A, Simpson DC, Skinner N, Whitehead L, Wozney L. Do Single-Family Rooms Increase Parental Presence, Involvement, and Maternal Well-Being in Neonatal Intensive Care? J Perinat Neonatal Nurs 2021; 35:350-361. [PMID: 34726653 DOI: 10.1097/jpn.0000000000000600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives of this study were to determine whether single-family room (SFR) design enhances parental presence, involvement, and maternal well-being during neonatal intensive care hospitalization. An observational cohort including mothers of infants was randomly assigned to receive care in a tertiary-level open-bay (OB) (n = 35) or SFR (n = 36). Mothers were asked to complete daily diaries documenting parental presence, involvement in care, and questionnaires examining maternal well-being. Mother and father mean presence (standard deviation) was significantly higher in the SFR-17.4 (5.2) and 13.6 (6.8)-compared to OB-11.9 (6.3) and 4.6 (3.7) hours/day. Total time spent in care activities did not differ for mothers, except SFR mothers spent more time expressing breast milk (EBM). SFR fathers had greater involvement with care activities. There were no other significant differences. The SFR was associated with greater maternal presence, but not greater involvement in care activities except for EBM, nor improved maternal well-being. The SFR appears to have greater impact on fathers' involvement in care and comforting activities, although the amount of time involved remained quite low compared with mothers. Further studies examining ways to enhance parental involvement in the neonatal intensive care unit are warranted.
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Affiliation(s)
- Marsha Campbell-Yeo
- IWK Health, Halifax, Nova Scotia, Canada (Drs Campbell-Yeo, Kim, Dorling, Macmillan, Mcgrath, Simpson, and Wozney and Mss Bishop, Delahunty-Pike, Glover, Inglis, Johnson, Monaghan, Skinner, and Whitehead); Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada (Drs Campbell-Yeo, Disher, Richardson, and Dol); Department of Pediatrics (Drs Campbell-Yeo, Dorling, Macmillan, Simpson) and Department of Psychiatry (Dr Mcgrath), Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; and Department of Medical Sciences, Faculty of Science, Dalhousie University, Halifax, Nova Scotia, Canada (Ms Orovec)
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Savard C, Yan E, Plante AS, Bégin C, Robitaille J, Michaud A, Lemieux S, Provencher V, Morisset AS. Positive attitudes toward weight gain in late pregnancy are associated with healthy eating behaviours. Eat Weight Disord 2021; 26:2051-2058. [PMID: 33128720 DOI: 10.1007/s40519-020-01057-5] [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: 08/11/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This cross-sectional study examined the associations between 3rd trimester attitudes toward weight gain and (1) pre-pregnancy BMI, (2) gestational weight gain (GWG) and (3) eating behaviours assessed in the 3rd trimester. METHODS Seventy-nine (79) pregnant women completed the French version of the Pregnancy Weight Gain Attitude Scale (PWGAS), the Three-Factor Eating Questionnaire (TFEQ) and the Intuitive Eating Scale-2 (IES-2) in their 3rd trimester. Total GWG was calculated as the difference between the weight recorded before delivery and self-reported pre-pregnancy weight. RESULTS Most (55.6%) women gained weight above the Institute of Medicine's (IOM) recommendations, but there was no association between PWGAS scores and total or 3rd trimester GWG. Women with obesity had lower PWGAS total scores compared to women with overweight (3.48 ± 0.6 vs. 3.99 ± 0.3, p = 0.005), indicating more negative attitudes in women with obesity vs. overweight. Higher total PWGAS scores were positively correlated with intuitive eating scores (r = 0.28, p < 0.05), and inversely associated with unfavourable eating behaviours such as dietary restraint (r = - 0.42, p < 0.01). CONCLUSION Women with positive attitudes toward weight gain reported healthier eating behaviours in late pregnancy, which remains to be confirmed in prospective studies. Interventions addressing body image issues during pregnancy may positively influence pregnant women's health, including eating behaviours. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Claudia Savard
- School of Nutrition, Laval University, Québec City, Canada
- Institute of Nutrition and Functional Foods, NUTRISS Research Center, Laval University, Québec City, Canada
- Endocrinology and Nephrology Unit, CHU of Québec-Université Laval Research Center, Québec City, Canada
| | - Emmanuelle Yan
- Biology's Formation and Research Unit, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Anne-Sophie Plante
- Endocrinology and Nephrology Unit, CHU of Québec-Université Laval Research Center, Québec City, Canada
| | - Catherine Bégin
- School of Nutrition, Laval University, Québec City, Canada
- School of Psychology, Laval University, Québec City, Canada
| | - Julie Robitaille
- School of Nutrition, Laval University, Québec City, Canada
- Institute of Nutrition and Functional Foods, NUTRISS Research Center, Laval University, Québec City, Canada
- Endocrinology and Nephrology Unit, CHU of Québec-Université Laval Research Center, Québec City, Canada
| | - Andréanne Michaud
- School of Nutrition, Laval University, Québec City, Canada
- Institute of Nutrition and Functional Foods, NUTRISS Research Center, Laval University, Québec City, Canada
- Québec Heart and Lung Institute Research Center, Laval University, Québec City, Canada
| | - Simone Lemieux
- School of Nutrition, Laval University, Québec City, Canada
- Institute of Nutrition and Functional Foods, NUTRISS Research Center, Laval University, Québec City, Canada
| | - Véronique Provencher
- School of Nutrition, Laval University, Québec City, Canada
- Institute of Nutrition and Functional Foods, NUTRISS Research Center, Laval University, Québec City, Canada
| | - Anne-Sophie Morisset
- School of Nutrition, Laval University, Québec City, Canada.
- Institute of Nutrition and Functional Foods, NUTRISS Research Center, Laval University, Québec City, Canada.
- Endocrinology and Nephrology Unit, CHU of Québec-Université Laval Research Center, Québec City, Canada.
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Loureiro F, Oliveira P. On "Parents' Experiences With a Model of Integrated Maternity and Neonatal Care Designed to Empower Parents". J Obstet Gynecol Neonatal Nurs 2021; 50:512-514. [PMID: 34033758 DOI: 10.1016/j.jogn.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 11/25/2022] Open
Abstract
The idea of intervening with the family as a whole using an integrated model of care is an important goal for practice and future research.
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Yang M, Du J, Yang Q, Dou W, Jiang M, Hei M. Influence of Family Integrated Care on the Intestinal Microbiome of Preterm Infants With Necrotizing Enterocolitis and Enterostomy: A Preliminary Study. Front Pediatr 2021; 9:678254. [PMID: 34900854 PMCID: PMC8662560 DOI: 10.3389/fped.2021.678254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to investigate the influence of family integrated care (FICare) on the intestinal microbiome of preterm infants with necrotizing enterocolitis and enterostomy. This was a prospective pilot study at Beijing Children's Hospital. Premature infants with an enterostomy who met the enrollment criteria were divided into the 2-week FICare and non-FICare groups (non-randomly). We collected their fecal samples and subjected the intestinal microbiomes to 16S rRNA gene sequencing. Operational taxonomic units (OTU) were analyzed to assess the intestinal microbiome richness, and we then carried out α-diversity, β-diversity, and species clustering analyses and a linear discriminant analysis (LDA) effect size (LEfSe) analysis to identify the differences in the microbial communities between the two groups. There were 12 patients enrolled in the study (FICare, n = 7; non-FICare, n = 5). There were no significant between-group differences in demographic characteristics, or in the relative abundances of phyla and genera. The major bacterial phyla were Proteobacteria, Firmicutes, and Actinobacteria, and Serratia, Enterococcus, Cronobacter, and Bifidobacterium dominated at the genus level. The α-diversity analysis indicated that the intestinal flora was more diverse in the non-FICare group than the FICare group (p < 0.05). However, most of the other indicators did not suggest a difference between the two groups. There was a high proportion of shared OTUs between the two groups, and the PCoA and clustering analyses indicated that the two groups were difficult to distinguish, indicating that the intestinal microbiomes were relatively similar between the groups. In summary, short-term FICare had no significant positive effect on the establishment of intestinal flora diversity in premature infants with necrotizing enterocolitis and enterostomy. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-OPN-17011801).
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Affiliation(s)
- Mengyang Yang
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| | - Juan Du
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| | - Qin Yang
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| | - Wenyan Dou
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| | - Min Jiang
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| | - Mingyan Hei
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
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van Veenendaal NR, van Kempen AA, Franck LS, O'Brien K, Limpens J, van der Lee JH, van Goudoever JB, van der Schoor SR. Hospitalising preterm infants in single family rooms versus open bay units: A systematic review and meta-analysis of impact on parents. EClinicalMedicine 2020; 23:100388. [PMID: 32548575 PMCID: PMC7284081 DOI: 10.1016/j.eclinm.2020.100388] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Many parents develop stress-related symptoms and depression when their preterm infant is hospitalised in the neonatal intensive care unit (NICU) after birth. We reviewed the evidence of parent well-being with preterm infants hospitalised in single family rooms (SFRs) or in open bay neonatal units (OBUs). METHODS For this systematic review and meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP) databases from inception through 22 November 2019 using controlled terms and text words related to prematurity and NICU-design. We included randomised and non-randomised studies comparing outcomes in parents with preterm infants admitted to SFRs or OBUs. Methodological quality was assessed using Cochrane Collaboration's Risk of Bias Tool for randomised controlled trials and the Risk of Bias Tool for Non-Randomised Studies of Interventions (ROBINS-I). Outcomes included: parental stress, satisfaction, participation (presence/involvement/skin-to-skin care), self-efficacy, parent-infant-bonding, depression, anxiety, post-traumatic stress, empowerment, and degree of family-centred care. Summary estimates were calculated using random effects models with standardised mean differences (SMDs). PROSPERO registration: CRD42016050643. FINDINGS We identified 614 unique publications. Eleven study populations (1, 850 preterm infants, 1, 549 mothers and 379 fathers) were included. All but one study were at serious to critical risk of bias. SFRs were associated with higher levels of parental presence, involvement, and skin-to-skin care. Upon discharge, SFRs were associated with lower stress levels (n = 828 parents, SMD-0·30,95%CI -0·50;-0·09, p<0·004, I2=46%), specifically NICU-related stress (n = 573, SMD-0·42,95%CI -0·61;-0·23, p<0·0001, I2=0%). In majority of studies higher levels of empowerment, family-centred care, and satisfaction was present with SFRs. No differences were found for anxiety, parent-infant bonding, or self-efficacy. Depression was high (up to 29%) but not different between settings. No studies described post-traumatic stress. INTERPRETATION Single family rooms seem to facilitate parental presence, involvement, skin-to-skin care, and reduce NICU-related parental stress.
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Key Words
- AA, at admission
- BA, before-after study
- BDI, Beck Depression Inventory
- CI, confidence interval
- EPDS, Edinburgh Postnatal Depression Scale
- FCC, Family-Centred Care
- FCCS, Family-Centred Care Survey
- MPAS, Maternal Postnatal Attachment Scale
- Mo, months
- NA, not applicable
- NICU, Neonatal Intensive Care Unit
- NR, not reported
- NRPI, non-randomised prospective intervention study
- NRRI, non-randomised retrospective intervention study
- OBU, Open Bay Unit
- PES, Parent Expectations Scale
- PG, Press Ganey NICU Survey
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analysis
- PROSPERO, International Prospective Register of Systematic Reviews
- PSI, Parental Stress Index
- PSS-NICU, Parental Stressor Scale – NICU
- RCT, Randomised Controlled Trial
- ROBINS-I, Risk of Bias in Non-randomised Studies of Interventions
- RoB, Risk of Bias
- SD, standard deviation
- SFR, Single Family Room
- SMD, standardised mean difference
- SPSQ, Swedish Parental Stress Index
- STAI, State-Trait Anxiety Inventory
- Wks, weeks
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Affiliation(s)
- Nicole R. van Veenendaal
- Department of Pediatrics/Neonatology, OLVG, Amsterdam, Netherlands
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
| | | | - Linda S. Franck
- School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Karel O'Brien
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada
| | - Jacqueline Limpens
- Medical Library Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna H. van der Lee
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Johannes B. van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
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Asmundson GJ, Blackstock C, Bourque MC, Brimacombe G, Crawford A, Deacon SH, McMullen K, McGrath PJ, Mushquash C, Stewart SH, Stinson J, Taylor S, Campbell-Yeo M. Easing the disruption of COVID-19: supporting the mental health of the people of Canada—October 2020—an RSC Policy Briefing. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic has had a significant impact on the mental health of the people of Canada. Most have found it challenging to cope with social distancing, isolation, anxiety about infection, financial security and the future, and balancing demands of work and home life. For some, especially those who have had to face pre-existing challenges such as structural racism, poverty, and discrimination and those with prior mental health problems, the pandemic has been a major impact. The Policy Briefing Report focuses on the current situation, how the COVID-19 pandemic has exacerbated significant long-standing weaknesses in the mental health system and makes specific recommendations to meet these challenges to improve the well-being of the people of Canada. The COVID-19 pandemic has had a detrimental effect on mental health of people in Canada but the impact has been variable, impacting those facing pre-existing structural inequities hardest. Those living in poverty, and in some socially stratified groups facing greater economic and social disadvantage, such as some racialized and some Indigenous groups and those with preexisting mental health problems, have suffered the most. Some occupational groups have been more exposed to the virus and to psychological stress with the pandemic. The mental health care system was already overextended and under resourced. The pandemic has exacerbated the problems. The care system responded by a massive move to virtual care. The future challenge is for Canada to strengthen our knowledge base in mental health, to learn from the pandemic, and to provide all in Canada the support they need to fully participate in and contribute to Canada’s recovery from the pandemic.
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Affiliation(s)
| | - Cindy Blackstock
- First Nations Child and Family Caring Society of Canada, Ottawa, ON, Canada
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Marie Claire Bourque
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Glenn Brimacombe
- Policy and Public Affairs, Canadian Psychological Association, Ottawa, ON, Canada
| | - Allison Crawford
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - S. Hélène Deacon
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Ken McMullen
- Emergency Services, The City of Red Deer, Red Deer, AB, Canada
| | - Patrick J. McGrath
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Chair of the Working Group, Halifax, NS, Canada
| | - Christopher Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
- Dilico Anishinabek Family Care, Thunder Bay, ON, Canada
| | - Sherry H. Stewart
- Departments of Psychiatry and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Stinson
- Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Steven Taylor
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University and IWK Health, Halifax, NS, Canada
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