Effect of newborn's admission to intensive care unit on "quality of life" of mother: an Indian perspective

The Factors Associated With Continuous Positive Airway Pressure (CPAP) Failure in Late Preterm and Term Infants and Its Impact on In-Hospital Outcomes

Background and objective Late preterm and term infants commonly require continuous positive airway pressure (CPAP) on admission. However, CPAP failure in this population has not been well studied. Hence, we conducted this study to determine the impact of CPAP failure and identify antenatal factors associated with it in late preterm and term infants. Materials and methods We carried out a single-center retrospective analysis of all inborn infants of ≥34 weeks gestational age (GA) from 2012 to 2019 who received CPAP on admission to the neonatal intensive care unit (NICU). CPAP failure was defined as follows: escalation in the mode of respiratory support, surfactant administration, increase in FiO2 >0.2 above the baseline, or absolute FiO2 >0.4 for ≥3h; within 12h of admission. In-hospital outcomes and perinatal factors were compared between CPAP-failure and success groups. Multivariate stepwise binary logistic regression analysis (LRA) was used to assess the association between antenatal factors and CPAP failure.  Results Of the 272 infants included in the study, 38 (14%) failed CPAP. Infants in the failure group received a longer duration of respiratory support [median (IQR): 3.0 (5.6) vs. 0.5 (0.5)d; p<0.001], and length of stay [9 (9) vs. 4 (4)d; p<0.001]. On LRA, higher GA was associated with reduced odds of CPAP failure. Maternal hypertensive disorders, meconium-stained amniotic fluid, and group B Streptococcus (GBS)-positive status were associated with increased odds of CPAP failure. Conclusions In this cohort of late preterm and term infants, CPAP failure was associated with worse in-hospital outcomes. Lower GA, maternal hypertensive disorders, meconium-stained amniotic fluid, and GBS-positive status were associated with CPAP failure. These data, if replicated in further studies, may help develop individualized respiratory support strategies.

Stress and stressors experienced by the parents of high-risk neonates admitted in neonatal intensive care unit: Systematic review and meta-analysis evidence available from India

The aim of the systematic review and meta-analysis is to determine the stress and stressors experienced by the parents of high-risk neonates admitted to the neonatal intensive care unit (NICU) in India. We included both quantitative and qualitative studies. The Joanna Briggs Institute Critical Appraisal Checklist and Critical Appraisal Skill Programme checklist were used to assess the quality of included studies. A systematic search was conducted in PubMed, EMBASE, SCOPUS, EBSCOhost, Web of Science, ProQuest, Microsoft Academic, DOAJ, Indian Citation Index, and J-Gate to identify relevant studies. Additionally, online hand searching was performed on Indian websites of relevant institutions, women and child health departments, repositories, registries, and paediatric journals. Twelve of the 21 quantitative studies found that maternal stress was higher than fathers due to the separation from their babies and the medical condition of the neonate. One qualitative study reported that financial burden, alterations in the parenting role, and concern over domestic issues are significant causes of fathers' stress. A meta-analysis of the included studies assessed the prevalence of maternal, paternal, and parental stress and reported that mothers experienced higher stress levels than fathers across all subscales. The most typical stressors for parents were changes in neonatal looks, behaviour, and altered parental roles. Beyond the immediate NICU care and interactions, other triggering factors of stress among parents must be considered to design multicomponent interventions in a local (Indian) context. Moreover, parental psychological support and regular counselling can be incorporated into the standard neonatal intensive care policy.

Prevalence of mental health problems in mothers of preterm infants admitted to NICU: A cross-sectional study

OBJECTIVE

To study the prevalence of mental health problems among mothers of preterm infants admitted to the neonatal intensive care unit (NICU).

METHODS

In this cross-sectional two-arm study, 130 mothers in each group, with either term infants not in NICU or preterm infants admitted to NICU, underwent mental health assessment using the Generalized Anxiety Disorder Scale, Centre for Epidemiologic Studies-Depression Scale, Stanford Acute Stress Reaction Questionnaire and Modified Parental Stress Scale-NICU. Their coping styles and quality of life were also assessed. Data were analyzed using SPSS IBM 25.0.

RESULTS

Anxiety (66.2% versus 46.9%) and depression (45.4% versus 23.1%) were more common among NICU mothers. Regarding subdomains of acute stress reaction, a higher number of NICU mothers showed symptoms of anxiety, re-experience and functional impairment. For mothers with infants in NICU, sight, sound, and parental role alterations were stressful. They had reduced quality of life scores in domains of physical health, psychological health, and social relationships. Also, a higher number of these mothers exhibited problem-solving and emotion-focused coping.

CONCLUSION

Preterm birth with NICU admission of the infant is more stressful for a mother than the term birth of a healthy neonate. It affects her mental health and quality of life. Both the obstetrician and the pediatrician should be mindful of this.

Mothers' quality of life delivering kangaroo mother care at Malawian hospitals: a qualitative study

Introduction

Kangaroo mother care is known to help save the lives of preterm and low birthweight infants, particularly in resource-limited health settings, yet barriers to implementation have been documented. Mothers and their families are very involved in the process of providing kangaroo mother care and the impact on their well-being has not been well explored. The objective of this research was to investigate the perspectives and experiences of a mother’s quality of life while delivering facility-based kangaroo mother care.

Methods

This study is a secondary analysis of the qualitative data collected within the “Integrating a neonatal healthcare package for Malawi” project. Twenty-seven health workers and 24 caregivers engaged with kangaroo mother care at four hospitals in southern Malawi were interviewed between May–August 2019. All interviews were face-to-face and followed a topic guide. Content analysis was conducted on NVivo 12 (QSR International, Melbourne, Australia) based on the six World Health Organization Quality of Life domains (physical, psychological, level of independence, social relationships, environment, spirituality).

Results

Fifty-one interviews were conducted with 24 caregivers and 14 health workers. Mothers experienced multidimensional challenges to their quality of life while delivering facility-based KMC. Though kangaroo mother care was considered a simple intervention, participants highlighted that continuous kangaroo mother care was difficult to practice. Kangaroo mother care was an exhausting experience for mothers due to being in one position for prolonged periods, compromised sleep, restricted movement, boredom, and isolation during their stay at the hospital as well as poor support for daily living needs such as food.

Discussion

A heavy burden is placed on mothers who become the key person responsible for care during kangaroo mother care, especially in resource-limited health settings. More focus is needed on supporting caregivers during the delivery of kangaroo mother care through staff support, family inclusion, and conducive infrastructure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01823-8.

Impact of a Parent Video Viewing Program in the Neonatal Intensive Care Unit

Purpose: Video visits, or televisits, have become increasingly popular across various medical subspecialties. Within the University of California, Davis, Neonatal Intensive Care Unit, a video visitation program known as FamilyLink allows families to remotely view their babies when they are otherwise unable to visit. This study aimed to explore parents' perceived effects of video camera use as well as the relationship of video visit use with rates of breast milk feedings at hospital discharge. Materials and Methods: Families enrolled in this study completed a series of two identical surveys that gathered self-reported data on their experiences during their infant's hospitalization. Comparisons were made considering whether the FamilyLink program was utilized during the admission as well as changes in self-reported experiences over the time course of the hospital admission. The type of enteral feeding at discharge was recorded and reviewed for each baby. Results: Of 100 families enrolled in the study, 30 were found to have used FamilyLink to visit with their baby. The use of FamilyLink was associated with survey findings of sustained intention to breastfeed or provide breast milk to the baby, as well as increased perceived parental involvement in the baby's care. Improved rates of breast milk feedings at the time of discharge were also found among babies whose families conducted televisits using FamilyLink. Conclusions: Video viewing in the NICU has effected a positive impact on breast milk feedings and parents' feelings of involvement during the admission, with the potential to further improve on families' experiences with a hospitalized baby.