Paternal and maternal concerns for their very low-birth-weight infants transitioning from the NICU to home

Parents' information needs during the first year at home with their very premature born child; a qualitative study

Objective

To obtain insights into parents' information needs during the first year at home with their very preterm (VP) born infant.

Methods

We conducted semi-structured interviews with parents of VP infants participating in a post-discharge responsive parenting intervention (TOP program). Online interviews were audiotaped and transcribed verbatim. Inductive thematic analysis was performed by two independent coders.

Results

Ten participants were interviewed and had various and changing information needs during the developmental trajectory of their infant. Three main themes emerged; (1) Help me understand and cope, (2) Be fully responsible for my baby, and (3) Teach me to do it myself. Available and used sources, such as the Internet, did not meet their information needs. Participants preferred their available and knowledgeable healthcare professionals for reassurance, tailored information, and practical guidance.

Conclusion

This study identified parents' information needs during the first year at home with their VP infant and uncovered underlying re-appearing needs to gain confidence in child-caring abilities and autonomy in decision-making about their infants' care.

Innovation

This study provides valuable information for healthcare professionals and eHealth developers to support parental self-efficacy during the first year after preterm birth.

Reliability and validity of the Chinese post-discharge coping difficulty scale-parent form in parents of premature infants: a multicenter cross-sectional study

Background

The measurement of the coping difficulties of parents of premature infants after discharge provides objective data for nurses to prepare infants for discharge. However, no Chinese scale has been developed to measure parents' coping difficulties after their premature infants are discharged.

Aim

To translate the parent version of the Post-Discharge Coping Difficulty Scale (Ped-PDCDS) from English to Chinese and test the reliability and validity of the Chinese version in parents of premature infants.

Methods

A multicenter cross-sectional study of 356 parents of premature infants was conducted. The scale was symmetrically translated. Validity was evaluated in terms of content, construct, discriminant, and convergent validities. Reliability was assessed in terms of internal consistency, split-half reliability, and test-retest reliability.

Results

The Chinese Ped-PDCDS finally contained 11 items. Exploratory and confirmatory factor analyses results showed that the Chinese Ped-PDCDS had three dimensions, and the convergent and discriminant validities of the scale was satisfactory. The overall reliability, split-half reliability, and test-retest reliability of the scale was 0.85, 0.92, and 0.84, respectively.

Conclusion

The Chinese Ped-PDCDS has adequate psychometric properties, and is an easy and appropriate instrument for measuring parents' difficulty in coping with premature infants.

Parent Experiences in the NICU and Transition to Home

Families (n = 12) with infants born at <29 weeks gestation shared their experiences while in the NICU and transitioning home. Parents were interviewed 6-8 weeks after NICU discharge, including some during the acute phase of the COVID-19 pandemic. Findings regarding the parent experience in the NICU were focused around challenges navigating parent-infant separation, social isolation, communication difficulties, limited knowledge of preterm infants, mental health challenges. Parents also discussed supports that were present and supports they wished were present, as well as the impact of COVID-19 on their experiences. In the transition to home, primary experiences included the sudden nature of the transition, anxiety around discharge preparation, and the loss of the support from nursing staff. During the first few weeks at home, parents expressed joy and anxiety, particularly around feeding. The COVID-19 pandemic limited emotional, informational, and physical support to parents and resulted in limited mutual support from other parents of infants in the NICU. Parents of preterm infants in the NICU present with multiple stressors, rendering attending to parental mental health crucial. NICU staff need to address logistical barriers and familial priorities impacting communication and parent-infant bonding. Providing multiple opportunities for communication, participating in caretaking activities, and meeting other families can be important sources of support and knowledge for parents of very preterm infants.

Home Immunization with Palivizumab-A Randomized Pilot Study Describing Safety Aspects and Parents' Preferences

Among prematurely born infants and newborns with chronic conditions, a respiratory syncytial virus (RSV) infection may cause (re-)admission and later respiratory complications. Therapeutic protection is possible with monthly injections of a specific monoclonal antibody, palivizumab, during RSV season. Standard care is giving up to five injections in clinic-based settings. Immunization at home could be an alternative to standard care for vulnerable infants to reduce the number of revisits and associated risk of RSV infection. The aim of this randomized pilot trial was to evaluate safety aspects and explore parents' preferences of home versus hospital immunization with palivizumab during one RSV season. Immediate adverse events (AEs) were observed and registered by a pediatric specialist nurse. Late-onset AEs were reported by parents. Parents' perceptions were collected through a questionnaire and analyzed using content analysis. The study population consisted of 43 infants in 38 families. No immediate AEs occurred. Three late-onset AEs were reported in two infants in the intervention group. Three categories emerged in the content analysis: (1) protect and watch over the infant, (2) optimal health and well-being for the whole family, and (3) avoid suffering for the infant. The study results show that home immunization with palivizumab is feasible if safety aspects are considered and that parental involvement in the choice of place for immunization after a neonatal intensive care experience can be important.

Parental priorities in the home care of preterm and full term newborns

BACKGROUND

The initial weeks after hospital discharge is a period of adaptation when parents assume great responsibility for the care of their child. Preterm birth may impact their demands of care.

AIMS

To compare parental priorities in the care of preterm and full-term newborns in the first two months after hospital discharge and to identify changes in priorities over time.

METHODS

Parents of 22 full-term and 19 preterm infants were followed for two months after hospital discharge, with three timepoint evaluations of the parental priorities. They reported on infant care demands in a semi-structured interview.

RESULTS

Despite prematurity, demands were similar between groups. Within-group changes occurred over time. Priorities related to bathing and caring for the navel showed significant reduction (p < 0.01); demands related to children's health care increased in the groups (p < 0.01). Feeding and sleep priorities were reduced in the full-term group (p < 0.02). Children's adaptation to routine increased significantly in the preterm group (p = 0.04).

CONCLUSION

Knowledge of parents' priorities in caring for preterm or full-term newborns at home helps health care teams develop appropriate support strategies and improve specialized assistance to the families.

Family-centred care and breastfeeding self-efficacy determined how ready mothers were for their infants to be discharged from a neonatal intensive care unit

AIM

We examined if a range of factors were associated with how ready mothers were for their infants to be discharged from a neonatal intensive care unit (NICU).

METHODS

This was a secondary analysis of a study on the well-being of mothers whose infants were hospitalised in the level 3 NICU at the Jewish General Hospital in Canada. We studied 132 mother-infant dyads: 70 from an open ward NICU and 62 from the purpose-built NICU with pods or single family rooms that replaced it in 2016. The mothers completed a questionnaire on NICU stress and their perceptions of family-centred care on enrolment and another on breastfeeding self-efficacy and readiness to go home a week before discharge. The infants' characteristics were retrieved from the medical files.

RESULTS

The infants were born at a mean age of 29.8 ±3.1 weeks. Greater family-centred care during early hospitalisation (p=0.01) and greater breastfeeding self-efficacy in the period before discharge (p=0.04) were significantly associated with higher readiness for discharge. The unit design was not a significantly associated with readiness for discharge.

CONCLUSION

The quality of early family-centred care and breastfeeding self-efficacy were significantly associated with how ready mothers were for their preterm infant to be discharged from the NICU.

Exploring the needs and coping strategies of New Zealand parents in the neonatal environment

AIM

Having an infant admitted to a neonatal care facility can be highly distressing for parents given the fragile state of their child and the often-unfamiliar environment. This study aimed to explore the needs and coping strategies of parents in this setting.

METHODS

An online qualitative survey was used to explore the needs of parents who had a child discharged from a New Zealand neonatal unit in the past 12 months. A total of 394 parents participated in the study (387 mothers, 5 fathers), providing 970 responses across three open-ended questions examining their needs, unmet needs and coping strategies. The study included participants across both neonatal intensive care units and special care baby units, with prematurity (47%) the most common reason for admission. An inductive form of thematic analysis was used to analyse the data.

RESULTS

Four themes were developed that capture the needs and coping strategies expressed by parents in this study: communication and information; physical contact and access to the baby; emotional and non-medical support; and involvement, autonomy and respect.

CONCLUSIONS

The themes developed largely centre around the struggle parents face when confronting the uncertainty of the neonatal environment and the difficulty in establishing their parental role. Parental distress may be reduced through communicating accurate information regularly and providing empathetic understanding, while opportunities for physical contact and involvement may assist in raising parental confidence and scaffolding the journey to independent care of their infant.

The effect of Web-based preterm infant care training on mothers' self-confidence

The internet can be used as an alternative method in infant care education for mothers of preterm infants. This study was conducted to examine the effect of the Web-based infant care training program given to mothers of preterm infants on the self-confidence levels of mothers. This nonrandomized controlled study with a posttest design was conducted in Ministry of Health training and research hospital and university hospital. The study group comprised 84 mothers and their infants (intervention group: N = 42; control group: N = 42). Mothers with preterm infants in the intervention group participated in the Web-based program. The self-confidence of the mothers was evaluated before and after the training. The mothers' Pharis self-confidence scale mean scores were higher than the control group, but there was no significant difference. Web-based education program can be an alternative method that can be used in the education of mothers with preterm infants.

Transition From the Neonatal Intensive Care Unit to Home: A Concept Analysis

BACKGROUND

A successful transition from the neonatal intensive care unit to home is fundamental for the long-term health and well-being of preterm infants; however, the process parents' experience during their transition home is poorly understood. An improved understanding of this concept will allow nurses to offer families comprehensive and collaborative discharge preparation.

PURPOSE

To describe the defining attributes, antecedents, and consequences for the concept of transition in the context of the neonatal intensive care unit to home.

METHODS

Databases, MEDLINE, CINAHL, PsycINFO, and EMBASE were searched for articles containing "transition" in combination with "neonatal intensive care unit" or variants of these terms. The Walker and Avant method was used for this concept analysis.

RESULTS

The defining attributes of transition in the context of the neonatal intensive care unit to home are "mix of emotions," "uncertainty," and "coming into parenthood." The principal antecedent is "hospital discharge preparation" and consequences include "feeding and medical needs," "family life changes," and "parental confidence."

IMPLICATIONS FOR PRACTICE

Gradually increasing parents' participation in their infant's care and forming a partnership and collaborative plan with families will help ease the uncertainty parents experience during their transition home.

IMPLICATIONS FOR RESEARCH

Further investigation is needed to determine how best to provide emotional support for parents during their transition home and to explore a feasible option for neonatal nurses to follow up with parents after hospital discharge.

The Development and Pilot of a Technology-Based Intervention in the United States for Father's Mental Health in the Perinatal Period

Paternal mental health is increasingly recognized as an important public health issue, with about 10% of men experiencing depression perinatally. Paternal depression is associated with less responsive parenting, greater parenting stress, and suboptimal child development. In response to a lack of existing interventions that directly focus on fathers’ mental health in the United States, we developed and pilot tested the Fathers and Babies (FAB) intervention for use with partners of women enrolled in home visiting (HV) programs.

After a review of the extant literature, FAB was developed with input from HV stakeholders and infant mental health consultants. FAB was subsequently pilot tested with 30 father-mother dyads, with mixed-method data collected from a subset of intervention participants to assess intervention feasibility and acceptability and guide intervention refinement.

Five themes related to FAB content and delivery considerations emerged from the initial focus groups that were used to guide FAB development. Mixed-method data collected during the pilot study established that fathers receiving FAB reported its content appropriate and thought it was feasible to receive the intervention. Several recommendations for FAB revisions were also provided.

FAB is an innovative intervention developed for fathers from contemporary family structures that was well-received during its pilot testing. Feasibility and acceptability data suggest that fathers have favorable opinions about intervention content and delivery, while also highlighting areas for future revisions of FAB.

Maternal and Paternal Depression Symptoms During NICU Stay and Transition Home

OBJECTIVE

To examine the trajectory and risk factors of depression symptoms among parents from NICU admission to 30 days postdischarge. We hypothesized depression symptom scores would decrease from admission and then increase from discharge to 30 days.

METHODS

Prospective longitudinal cohort study of premature infants in NICU. Parents completed the validated Edinburgh Postnatal Depression Scale (EPDS) at 4 time points: NICU admission, discharge, and 14 days and 30 days postdischarge. EPDS score change across time and probability of a positive screen (EPDS ≥10) were by assessed using mixed effect regression models.

RESULTS

Of 431 parents enrolled (mothers, n = 230 [53%]), 33% of mothers (n = 57) and 17% of fathers (n = 21) had a positive EPDS screening. Score change was 1.9 points different between mothers and fathers (confidence interval [CI]: 1.3-2.6; P < .0001), with mothers decreasing 2.9 points (CI: 2.1-3.7; P < .0001) and fathers decreasing 1.0 points (CI: 0.1-2.0; P = .04). Over time, mothers decreased 10.96 times (CI: 2.99-38.20; P = .0003); fathers decreased at a nonsignificant rate. Admission or discharge screening improved 30-day depressive symptom prediction (AUC 0.66 baseline demographics only versus 0.84+initial [P < .0001], and versus 0.80+discharge screening [P < .001]).

CONCLUSIONS

Mothers and fathers experience different depressive symptom trajectories from NICU to home. Screening parents for postpartum depression during the NICU stay is likely to result in improved identification of parents at risk for postpartum depression after discharge. Focused attention on fathers appears warranted.

Living with the Unknown: A Qualitative Study of Parental Experience of Prognostic Uncertainty in the Neonatal Intensive Care Unit

OBJECTIVE

This study aims to characterize the experience of prognostic uncertainty for neonatal intensive care unit (NICU) parents.

STUDY DESIGN

We conducted a qualitative interview study of current and former NICU parents regarding their experience with prognostic uncertainty in the NICU. Interviews were transcribed and analyzed using a grounded theory methodology.

RESULTS

Twenty-four parents were interviewed before achieving thematic saturation. Three phases of the parental experience of prognostic uncertainty emerged: shock, gray daze, and looking forward. These phases often, but not always, occurred sequentially. In shock, parents felt overwhelmed by uncertainty and were unable to visualize a future for their family. In gray daze, parents felt frustrated by the continued uncertainty. While accepting the possibility of a future for their family, they could not conceptualize a path by which to achieve it. In looking forward, parents accepted uncertainty as inevitable and incorporated it into their vision of the future.

CONCLUSION

While each parent experienced the prognostic uncertainty in the neonatal intensive care unit in their own way, we found three common experiential phases. By understanding how a parent experiences prognostic uncertainty in these phases, providers may become better able to communicate and form therapeutic relationships with parents.

When is My Baby Going Home? Moderate to Late Preterm Infants are Discharged at 36 Weeks Based on Admission Data

OBJECTIVE

This study evaluates the effect of admission characteristics of uncomplicated moderate to late preterm infants on timing of discharge. One of the first questions that families of infants admitted to the Neonatal Intensive Care Unit (NICU) ask is, "When is my baby going home?" Moderate to late preterm infants are the largest cohort of NICU patients but little data exist about their length of stay (LOS).

STUDY DESIGN

A retrospective electronic chart review was completed on 12,498 infants admitted to our NICU between January 1, 2009 and December 31, 2015. All inborn infants with a gestational age between 32^0/7 and 36^6/7 weeks were studied.

RESULTS

A total of 3,240 infants met our inclusion criteria. The mean postmenstrual age at discharge was 36^3/7 weeks. Infants who were small for gestational age were significantly more likely to have an increased LOS. Infants born between 34 and 36^6/7 weeks had a significantly increased LOS if they had respiratory distress syndrome. Admission diagnoses of neonatal abstinence syndrome, meconium aspiration syndrome, hydrops, hypoxic ischemic encephalopathy, biliary emesis, ABO incompatibly, and a genetic diagnosis all had increased LOS for all late preterm infants.

CONCLUSION

For uncomplicated moderate to late preterm infants, clinicians can counsel families that their infants will likely be discharged at 36 weeks of postmenstrual age. Small for gestational age infants and those with specific diagnoses may stay longer.

Fathers' Heightened Stress Responses to Recounting their NICU Experiences Months after Discharge: A Mixed Methods Pilot Study

OBJECTIVE

 The acute and traumatic events associated with having a newborn who requires admission to the neonatal intensive care unit (NICU) may elicit long-term concerns for parents postdischarge. Cognitive processing of taxing events influences recurring stress responses, which can be inferred via biomarkers such as salivary cortisol (sCort) and skin conductance (SC). In addition, personal narratives provide an important insight into individual perceptions and coping strategies. The current pilot study aimed to (1) test the hypotheses that fathers' sCort and SC would peak in response to stress induction and decrease during recovery, (2) examine associations among stress biomarkers and stress perceptions, (3) explore fathers' narratives using thematic analysis, and (4) integrate fathers' narrative themes with their stress responsivity.

STUDY DESIGN

 Using a convergent mixed methods approach, we enrolled 10 fathers of infants formerly cared for in NICU who underwent a Trier Social Stress Test including recounting their NICU experience months postdischarge. Stress responsivity was measured via sCort and SC, while stress perceptions were identified by using the Perceived Stress Scale and Distress Thermometer-Parent. Personal narratives were explored by using thematic analysis.

RESULTS

 The significant rise in fathers' sCort and SC in response to stress induction was reflected in narrative themes including loss, worry, and role strain. Subsequently, fathers' sCort and SC returned to baseline, which was illustrated by themes such as role strength, coping, and medical staff interactions. Fathers' stress measured by PSS was lower than that required for mental health referral, and did not correlate with stress biomarkers.

CONCLUSION

 Salivary cortisol and skin conductance are useful biomarkers of paternal stress responsivity and recovery. Thematic analysis identified fathers' NICU stressors and coping strategies that mirrored their stress responsivity patterns. Further studies are needed to more broadly examine the sociodemographic variables that influence stress reactivity and perceptions in parents of infants formerly cared for in NICU.

KEY POINTS

· Stress associated with NICU stay is impactful on fathers and may have long-term implications.. · Salivary cortisol and skin conductance are useful noninvasive stress biomarkers.. · Fathers' coping strategies included infant bonding, partner relationship, and trust building..

Being the Father of a Preterm-Born Child: Contemporary Research and Recommendations for NICU Staff

Background: Most studies on parental reactions to a preterm birth and to hospitalization of the newborn in Neonatal Intensive Care Units (NICUs) have involved mothers. However, emotional responses and behaviors of fathers are equally important. Usually, the father is the first to meet the preterm newborn, to find out information about baby's condition and to communicate to the mother and other family members. In this context he is often left alone and can show psychological difficulties including affective disorders such as depression or anxiety. This paper describes the role of fathers in the NICU, the best practices to support fathers, and to explain the role of a psychologist in the NICU staff. Considerations and suggestions are provided on the difficulties encountered to support parents, with a focus on the role of fathers during the COVID-19 pandemic. Methods and Discussion: Considering contemporary research data and following an attachment perspective, we analyze the role of the father of a preterm-born child in the relation with the partner and in newborn caring. Research has shown that involving fathers in newborn care in NICU and at home is essential not only because it promotes the father/son attachment relationship and has positive effects on the psychological and somatic development of the newborn, but also for the health of the mother and whole family. Conclusion: Recommendations are provided to enhance the functions of fathers in the NICU, promote their involvement in the care of their infant, and interventions to prevent the manifestation of psychological suffering and/or perinatal affective disorders. The commitments of a psychologist in a NICU team are presented and require not only clinical skills, but also the ability to manage the emotional and relational difficulties of fathers, family and NICU staff. Considerations and suggestions are provided on the difficulties encountered by parents in the NICU during the COVID-19 pandemic.

The Complexity of the NICU-to-Home Experience for Adolescent Mothers: Meleis' Transitions Theory Applied

Quality care for individuals and families during periods of transition is one of the major issues facing health care systems and providers today. The transition-home from the neonatal intensive care unit (NICU) as experienced by adolescent mothers is poorly understood-placing young mothers and their infants at risk of poor outcomes following NICU discharge. Meleis' Transitions Theory offers a unique theoretical perspective for understanding this transition experience and also serves to highlight the complexity of the NICU-to-home transition for this population of young mothers that is not currently elucidated in the literature.

Comparative Evaluation of Parental Stress Experiences Up to 2 to 3 Years After Preterm and Term Birth

Parenting stress after preterm birth (PTB) has negative long-term effects on parenting. Research about parental experiences after PTB and on parenting stress in early childhood has focused on mothers.

CARE FOR PRETERM CHILD IN HOUSE: FATHERLY EXPERIENCES

ABSTRACT Objective: to apprehend the paternal experiences related to the care provided to the preterm child at home by comparing the parents participating or not in the care protocol. Method: a qualitative research, conducted from July to October 2017, with 24 parents of preterm infants after discharge from a teaching hospital in the state of Paraná, Brazil, who participated or not in a care protocol during the period of hospitalization. The analysis was performed through the Collective Subject Discourse. Results: the parents who had the opportunity to participate in the protocol at the hospital reported that this care was important so that they could help their partners with their children at home. However, the parents participating or not in the protocol realize that the mother has a greater bond because of the possibility of greater time availability and because they are the nursing mothers and refer to work as a barrier to child care. Conclusion: the parents participating in the protocol report that it had a positive impact on their child care at home, in contrast, non-participating parents reported that having been included or not in the protocol did not interfere with their conduct at home. However, both groups agree that cultural factors and work are barriers to child care.

Transitioning Into the Role of Mother Following the Birth of a Very Low-Birth-Weight Infant: A Grounded Theory Pilot Study

This qualitative grounded theory pilot study investigated the concerns and coping mechanisms of mothers of very low-birth-weight (VLBW; <1500 g) infants following discharge from the neonatal intensive care unit in Alberta, Canada. In-depth, semistructured, face-to-face, audio-recorded interviews were conducted with women of VLBW infants. Interviews lasting 75 to 90 minutes were transcribed verbatim and coded using grounded theory methodology. Data saturation and theoretical redundancy were achieved in interviews with 6 mothers of VLBW infants. The core variable of "reconstructing normal" emerged from the interview data. Women indicated that mothering a VLBW infant is an unfolding experience that is continuously being revised, creating a new sense of normal. The construct consists of 4 categories; mother-infant relationship, maternal development, maternal caregiving and role-reclaiming strategies, and infant developmental milestones. Findings from this study suggest that women found the transition into motherhood following the birth of a VLBW infant as a multidimensional and dynamic process. Further research is warranted to confirm these results and to further explore mothering issues with VLBW infants.

Comparison of family centered care with family integrated care and mobile technology (mFICare) on preterm infant and family outcomes: a multi-site quasi-experimental clinical trial protocol

Background

Family Centered Care (FCC) has been widely adopted as the framework for caring for infants in the Neonatal Intensive Care Unit (NICU) but it is not uniformly defined or practiced, making it difficult to determine impact. Previous studies have shown that implementing the Family Integrated Care (FICare) intervention program for preterm infants in the NICU setting leads to significant improvements in infant and family outcomes. Further research is warranted to determine feasibility, acceptability and differential impact of FICare in the US context. The addition of a mobile application (app) may be effective in providing supplemental support for parent participation in the FICare program and provide detailed data on program component uptake and outcomes.

Methods

This exploratory multi-site quasi-experimental study will compare usual FCC with mobile enhanced FICare (mFICare) on growth and clinical outcomes of preterm infants born at or before 33 weeks gestational age, as well as the stress, competence and self-efficacy of their parents. The feasibility and acceptability of using mobile technology to gather data about parent involvement in the care of preterm infants receiving FCC or mFICare as well as of the mFICare intervention will be evaluated (Aim 1). The effect sizes for infant growth (primary outcome) and for secondary infant and parent outcomes at NICU discharge and three months after discharge will be estimated (Aim 2).

Discussion

This study will provide new data about the implementation of FICare in the US context within various hospital settings and identify important barriers, facilitators and key processes that may contribute to the effectiveness of FICare. It will also offer insights to clinicians on the feasibility of a new mobile application to support parent-focused research and promote integration of parents into the NICU care team in US hospital settings.

Trial registration

ClinicalTrials.gov, ID NCT03418870. Retrospectively registered on December 18, 2017.

Smartphones and Text Messaging are Associated With Higher Parent Quality of Life Scores and Enrollment in Early Intervention After NICU Discharge

The purpose of this study was to evaluate the impact of access to communication technology on caregiver quality of life, neurodevelopmental, and medical outcomes (eg, rehospitalization, emergency room visits, or surgeries) in preterm infants, and enrollment in public assistance programs. In this cross-sectional study, we surveyed families of preterm infants in a high-risk infant-follow-up clinic. We estimated associations of access to various modes of communication technology with outcomes, adjusting for sociodemographic and infant characteristics using linear and unconditional logistic regression. Access to email, text messaging, and smartphones was associated with higher quality of life scores on the Multicultural Quality of Life Index, and email and smartphone access was significantly associated with increased enrollment in early intervention. Evaluating smartphone and email access on neonatal intensive care unit discharge is important when considering enrollment in community programs and caregiver quality of life.

Mothers' Voices Related to Caregiving: The Transition of a Technology-Dependent Infant from the NICU to Home

PURPOSE

The transition from the NICU to home is a complicated, challenging process for mothers of infants dependent on lifesaving medical technology, such as feeding tubes, supplemental oxygen, tracheostomies, and mechanical ventilation. The study purpose was to explore how these mothers perceive their transition experiences just prior to and during the first three months after initial NICU discharge.

DESIGN

A qualitative, descriptive, longitudinal design was employed.

SAMPLE

Nineteen mothers of infants dependent on lifesaving technology were recruited from a large Midwest NICU.

MAIN OUTCOME VARIABLE

Description of mothers' transition experience.

RESULTS

Three themes were identified pretransition: negative emotions, positive cognitive-behavioral efforts, and preparation for life at home. Two posttransition themes were negative and positive transition experiences. Throughout the transition, the mothers expressed heightened anxiety, fear, and stress about life-threatening situations that did not abate over time despite the discharge education received.

Experiences of Mothers of Extremely Preterm Infants after Hospital Discharge

PURPOSE

The purpose of this study was to describe and understand the experiences of mothers of extremely preterm infants during the first twelve months at home following discharge from a neonatal intensive care unit.

DESIGN AND METHODS

A qualitative, interpretative approach using Gadamer's philosophical hermeneutics was carried out. One focus group and fifteen in-depth, semi-structured interviews were conducted twelve months after hospital discharge. Responses were recorded, transcribed and analyzed using computer-assisted qualitative data analysis.

RESULTS

The study´s participants were twenty women. The following themes emerged from the data analysis: 1) 'The journey home: the discharge process', which included the sub-themes 'escaping the hospital environment: between desire and fear' and 'preparing parents for hospital discharge: practice and formal support'; and 2) 'The difficulty of living with an extremely preterm infant', including the sub-themes 'the challenge of an unexpected form of childcare', 'overprotection of and bond with a child with special needs' and 'disturbance in the social/familiar setting: when a mother becomes a nurse'.

CONCLUSIONS

The process of hospital discharge and the first months at home are difficult. The birth and care of an extremely preterm infant affect the mothers' quality of life as well as their family and social life. Practice and early discharge programmes can make the discharge process easier.

PRACTICE IMPLICATIONS

The knowledge and understanding of the experience of mothers of extremely preterm infants in the first months at home after hospital discharge could help healthcare professionals to develop educational strategies and counselling interventions in accordance with the mothers' needs.

Mothers' experiences after coming home from the hospital with a moderately to late preterm infant - a qualitative study

BACKGROUND

Mothers of preterm infants are at greater risk of symptoms of stress and anxiety compared to mothers of term infants.

AIMS

This study aimed to explore mothers' experiences after coming home from the hospital with a moderately to late preterm infant.

METHODS

A qualitative and explorative method was used. Ten mothers who had given birth to a preterm baby with a gestational age between 30.0 and 36.0 were interviewed. The interviews were conducted two to three months after the mothers and their babies were discharged from hospital. The data were analysed by means of latent and manifest qualitative content analysis.

FINDINGS

One overall theme emerged from the analysis: 'Seeing the light at the end of the tunnel' and four categories were identified 'Finding a safe haven at home', 'Gaining support and learning to ensure optimal feeding', 'Seeing the child's possibilities' and 'Receiving professional attention and reassurance'. In particular, adequate breastfeeding guidance and help with practical tasks at home were emphasised as important for the mothers, and need to be incorporated into the practice of public health nurses.

CONCLUSIONS

Practical help and support from close people, combined with individual professional follow-up, were important for the mothers' ability to cope with the hospital-to-home transition. There should be a strong focus on breastfeeding guidance as the mothers experienced problems for several months after discharge, and felt they were missing out on breastfeeding guidance given to term babies in hospital.

Understanding the Effects of Neonatal Early Discharge on Parents: A Literature Review

A neonatal early discharge (NED) program is a supported process where preterm infants leave hospital before they have established full sucking feeds and are gavage fed by their parents while they transition to breast- and/or bottle-feeds. While there is some evidence in the literature describing the outcomes of this process for preterm infants, there is even more limited evidence of the effects and outcomes of these NED programs on parents. The objective of this study was to summarize and critically appraise the literature regarding the effects of NED on parents. A literature search was conducted for English language publications since 2007 using MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar. A total of 20 primary articles met the inclusion criteria for the review. An integrative thematic synthesis identified 4 themes: establishing parenting skills/confidence; bonding with the newborn; psychological distress; and the need for support and resources. Findings suggest that parents have various concerns regarding discharge from the neonatal unit and therefore support from healthcare professionals and family plays a crucial role during the experience. There were also various external factors such as socioeconomic status and cultural differences that impact on parents differently, and it is therefore challenging to draw definite conclusions. This warrants further research in the area.

Stress From the Neonatal Intensive Care Unit to Home: Paternal and Maternal Cortisol Rhythms in Parents of Premature Infants

To examine cortisol diurnal rhythms over the transition from the critical care setting to home for fathers and mothers of very low-birth-weight infants, including how cortisol is associated with psychosocial stress and parenting sense of competence. This cohort study in a level III neonatal intensive care unit and the general community had 86 parents complete salivary collection and self-reported psychosocial measures. Salivary samples were collected 3 times a day on the day before discharge, and on 3 subsequent days at home. Self-report measures included the Perceived Stress Scale and the Parenting Sense of Competence Scale, which measure parenting satisfaction. Fathers showed increased physiologic stress over the transition home, reflected by flattening of slopes, lower wakeup, and higher bedtime cortisol. Mothers reporting increases in perceived stress over the transition home had higher bedtime cortisol, suggesting a link between higher perceived stress and higher physiologic stress. Results were significant after controlling for breastfeeding, insurance status, and gestational age. This study examined a physiologic marker of stress in parents with very low-birth-weight infants, finding sex disparities in diurnal cortisol patterns during the transition from neonatal intensive care unit to the community. Fathers may be especially susceptible to stressors during this transition.

Collaboration challenges faced by nurses when premature infants are discharged

AIM

To explore the collaboration challenges faced by neonatal intensive care unit (NICU) nurses and public health nurses when preparing premature infants for transition home and to explore the culture of cooperation between the two professional groups.

METHOD

Qualitative individual interviews were undertaken with two NICU nurses and two public health nurses. A qualitative content analysis was used to analyse the data.

FINDINGS

Three main themes were identified: different expectations and lack of communication between NICU nurses and public health nurses; responsibilities and interactions between the two professional groups were not clearly defined; and the public health nurses' competence was not recognised by the NICU nurses and parents.

CONCLUSION

There is a need of clear guidelines about the discharge process from the NICU. This issue must be given further attention.

Parents' experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to identify, appraise and synthesize the best available studies exploring parents' experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit (NICU).The review questions are:

BACKGROUND

Giving birth to a premature or sick infant is a stressful event for parents. The parents' presence and participation in the care of the infant is fundamental to reduce this stress and to provide optimal care for both the premature or sick infant and family. A full term pregnancy is estimated to last between 37 and 40 weeks. Preterm infants born before 28 week (5.1%) are defined as extremely preterm, while those who are born between 28 to 31 weeks (10.3%) are defined as very preterm. The majority of the preterm (84.1%) are born between 32 to 37 week and may have significant medical problems requiring prolonged hospitalization.The prevalence of preterm birth is increasing worldwide. More than one in ten babies are born preterm annually. This is equal to 15 million preterm infants born globally and the second largest direct cause of deaths in children below five. The highest rates of preterm birth are in Sub-Saharan Africa and South Asia (more than 60%) and the lowest rates are in Northern Africa, Western Asia, Latin America and the Caribbean. The preterm birth rates in the developing countries vary widely and follow a different pattern than in high income countries.The preterm birth rate has increased between 1990 and 2010 with an average of 0.8% annually in almost all countries. Morbidity among critically ill newborn and preterm infants vary widely from no late effects to severe complications, such as visual or hearing impairment, chronic lung disease, growth failure in infancy and specific learning impairments, dyslexia and reduced academic achievement. Full term infants may also experience significant health problems requiring neonatal intensive care. The most common reasons for a full term infant to be admitted to a NICU after birth are temperature instability, hypoglycemia, respiratory distress, hyperbilirubinemia and neonatal mortality. Admission of a full term newborn infant from home within the first four weeks after birth is due to jaundice, dehydration, respiratory complications, feeding difficulties, urinary tract infection, diarrhea and meningitis.In the last two to three decades, technological advances in neonatalogy have improved the survival rates of critically ill and preterm infants.Two major issues have influenced the design of the NICU wards: i) the increased volume of preterm infants with extremely low gestational age who need neonatalogy assistance, and ii) the impact of the parents' presence in the NICU to support the infant's development.The health status of preterm babies can have a significant impact on the family wellbeing and function. The separation between the preterm infant and the parents is a threat to the attachment and bonding process. Worldwide, there has been a paradigm shift in the NICUs over the last decade, inviting parents to be admitted together with the infant or at least to spend most of the day together with their critical ill and preterm infant in the NICU. Parental involvement increases the performing of Kangaroo Mother Care during the admission in the NICU and increases parental preparedness for discharge to home. This change prepares the parents to take over tasks such as nurturing and feeding. The parents are the most important caregivers for the infant during the admission in the NICU and their co-admission increases the bonding and prepare the parents for the transition discharged to home.Family centered care (FCC) based on a partnership between families and professionals is described as essential in current research on neonatal care. Family centered care is facilitated by parental involvement, communication based on mutuality and respect, and unrestricted parental presence in the NICU. According to Mikkelsen and Frederiksen, the central attribute of FCC is partnership with the core value of mutuality and common goals.A NICU is a high-tech setting where highly specialized professionals care for premature or critically ill infants. During the infants' hospitalization, the relationship between parents and nurses evolves through an interchange of roles and responsibilities. However, this collaboration is challenging due to a discrepancy between parents' and nurses' expectations of their roles.To facilitate parents' skin-to-skin contact and involvement in their infant's care, NICUs are now redesigned to facilitate parents' "24-hour" presence, also called "rooming-in". Seporo et al. describes several benefits with "rooming-in" the NICUs. Staying in the same room increases infants' and parents' possibility for "skin-to-skin care". This improves the infant's sleep time and temperature regulation, decreased crying and need for oxygen, increases parental confidence and positive infant-parent interaction. Parents' experience of "skin-to-skin care" and "rooming in" may help parents to be acquainted with their infant and thus prepare for the transition to home. However, despite these positive effects of rooming-in, some negative effects, e.g. less sleep and lack of privacy, have been described by parents who have stayed with their child in a pediatric unit.The hospitalization may challenge the normal attachment process and parents' confidence as caregivers; parents' preparation for bringing the infant home is thus essential. The infant's discharge from the NICU is experienced as a moment of mixed feelings. Going home is a happy event, but at the same time it is combined with parental anxiety. Parents' pervasive uncertainty, medical concerns and adjustment to the new parental and partner-adjustment role are common concerns. To make parents confident and prepared for taking their infant home tailored information, guidance and hands-on experience caring for their infant before discharge is crucial.During the literature research we became aware of a systematic narrative review protocol by Parascandolo et al.'s concerning nurses', midwives', doctors' and parents' experiences of the preterm infants' discharge to home. The aim of our comprehensive review is to perform a metasynthesis on parents' perspectives and their experiences of transition from discharge from NICU to home. We will include qualitative primary studies to offer a deeper understanding of the parent perspective.

Effectiveness of the Neonatal Discharge Program for Very Low-Birth-Weight Infants on Parental Efficacy and Psychological Distress

This pilot study aimed to (i) evaluate the effectiveness of a neonatal discharge program, (ii) identify relationships between parent and infant factors and parental efficacy and psychological distress, and (iii) identify ways to improve the neonatal discharge program. A quasiexperimental 1-group pretest/posttest design was used. Through consecutive sampling, 42 participants were recruited. Data were collected using self-report questionnaires. Self-administering instruments gathered data on parental efficacy and psychological distress as well as feedback and recommendations on the intervention. A significant increase in parental efficacy and a reduction in psychological distress were observed from pre- to postdischarge intervention. Significant relationships were found between parental efficacy and infants' gestational age, birth weight, gender, and participants' level of education, and a significant relationship was found between psychological distress and number of children from previous pregnancies. Moreover, an Internet-based program, in addition to the face-to-face teaching, was identified as a preferred option to aid in information retention. It is important to evaluate and enhance the neonatal discharge program to suit the parents of today while providing them with informational and emotional support. Future studies should explore parental coping and the long-term effects of their infant's birth and the intervention.

"Giving us hope": Parent and neonatal staff views and expectations of a planned family-centred discharge process (Train-to-Home)

BACKGROUND

Preparing families and preterm infants for discharge is relatively unstructured in many UK neonatal units (NNUs). Family-centred neonatal care and discharge planning are recommended but variable.

DESIGN AND PARTICIPANTS

Qualitative interviews with 37 parents of infants in NNUs, and 18 nursing staff and 5 neonatal consultants explored their views of discharge planning and perceptions of a planned family-centred discharge process (Train-to-Home). Train-to-Home facilitates communication between staff and parents throughout the neonatal stay, using a laminated train and parent booklets.

RESULTS

Parents were overwhelmingly positive about Train-to-Home. They described being given hope, feeling in control and having something visual to show their baby's progress. They reported positive involvement of fathers and families, how predicted discharge dates helped them prepare for home and ways staff engaged with Train-to-Home when communicating with them. Nursing staff reactions were mixed-some were uncertain about when to use it, but found the visual images powerful. Medical staff in all NNUs were positive about the intervention recognizing that it helped in communicating better with parents.

CONCLUSIONS

Using a parent-centred approach to communication and informing parents about the needs and progress of their preterm infant in hospital is welcomed by parents and many staff. This approach meets the recommended prioritization of family-centred care for such families. Predicted discharge dates helped parents prepare for home, and the ways staff engaged with Train-to-Home when communicating with them helped them feel more confident as well as having something visual to show their baby's progress.

Perspectives of Low Socioeconomic Status Mothers of Premature Infants

BACKGROUND AND OBJECTIVES

Transitioning premature infants from the NICU to home is a high-risk period with potential for compromised care. Parental stress is high, and families of low socioeconomic status may face additional challenges. Home visiting programs have been used to help this transition, with mixed success. We sought to understand the experiences of at-risk families during this transition to inform interventions.

METHODS

Mothers of infants born at <35 weeks' gestation, meeting low socioeconomic status criteria, were interviewed by telephone 30 days after discharge to assess caregiver experiences of discharge and perceptions of home visitors (HVs). We generated salient themes by using grounded theory and the constant comparative method. Interviews were conducted until thematic saturation was achieved.

RESULTS

Twenty-seven mothers completed interviews. Eighty-five percent were black, and 81% had Medicaid insurance. Concern about infants' health and fragility was the primary theme identified, with mothers reporting substantial stress going from a highly monitored NICU to an unmonitored home. Issues with trust and informational consistency were mentioned frequently and could threaten mothers' willingness to engage with providers. Strong family networks and determination compensated for limited economic resources, although many felt isolated. Mothers appreciated HVs' ability to address infant health but preferred nurses over lay health workers.

CONCLUSIONS

Low-income mothers experience significant anxiety about the transition from the NICU to home. Families value HVs who are trustworthy and have relevant medical knowledge about prematurity. Interventions to improve transition would benefit by incorporating parental input and facilitating trust and consistency in communication.

Medical Surveillance and Child Maltreatment Incidence Reporting among NICU Graduates

Objective of this study is to identify background infant and maternal characteristics that predict child maltreatment (CM) incidence reporting among Neonatal Intensive Care Unit (NICU) graduates by health care providers versus community sentinels with the goal of identifying ways to improve CM risk surveillance. Demographic, medical data including diagnoses and caregiving needs at discharge for infants treated in a NICU during 2005 to 2008 were obtained from the neonatology databases. CM outcome data was obtained from child welfare databases. Latent class analysis procedures were used to identify observable infant and maternal characteristics that define unobserved groups (latent classes) that predict NICU graduates CM incidence reporting among health care providers versus community sentinels. Medical surveillance (reports made by health care providers) accounted for only 37% of the CM reports made to child welfare. Infant health was more predictive of medical surveillance than maternal characteristics suggesting that health providers may assess risk differently than community sentinels. Based on a simple, two latent class model, the latent class with high infant health indicator membership probabilities was a better predictor of health care provider related reports than the class with lower membership probabilities (odds ratio = 2.72; 95% confidence interval [1.76, 4.20]). Health care providers may be keyed more to an infant's medical frailty than to caregiver (maternal) contextual characteristics and thus may miss an opportunity to identify and intervene to prevent CM among children with medical problems. Findings raise the question of whether increased attention to contextual factors can aid or increase early identification of infants at risk of child maltreatment in NICU settings.

Paternal and Maternal Testosterone in Parents of NICU Infants Transitioning Home

Lower testosterone during the transition to new parenthood is considered beneficial to help parents better engage with their infants. No data currently exist studying salivary testosterone of parents with infants in neonatal intensive care units (NICUs) during the transition to home. We examine testosterone levels for parents of very low-birth-weight infants, including links between salivary testosterone and infant factors (such as breast-feeding), psychosocial stress, and changes over time.Testosterone salivary samples were assayed after self-collection by 86 parents (43 fathers and 43 mothers) with NICU infants at wakeup and bedtime prior to discharge and at 3 additional times at home. Self-reported survey measures, including psychosocial reports, were also collected at these times.Using multilevel modeling approaches, we report significant associations between paternal testosterone by time and psychosocial adjustment and between both paternal and maternal testosterone and infant feeding mode (P < .05). Results were significant after accounting for covariates. Our study is the first to examine the time course of diurnal testosterone for parents of premature infants over the transition home; as such, we suggest further research into better understanding parental physiology in this vulnerable parent population.

A Framework of Complex Adaptive Systems: Parents As Partners in the Neonatal Intensive Care Unit

Advances in neonatal care are allowing for increased infant survival; however, neurodevelopmental complications continue. Using a complex adaptive system framework, a broad analysis of the network of agents most influential to vulnerable infants in the neonatal intensive care unit (NICU) is presented: parent, nurse, and organization. By exploring these interconnected relationships and the emergent behaviors, a model of care that increases parental caregiving in the NICU is proposed. Supportive parent caregiving early in an infant's NICU stay has the potential for more sensitive caregiving and enhanced opportunities for attachment, perhaps positively impacting neurodevelopment.

Supporting Parents of Premature Infants Transitioning from the NICU to Home: A Pilot Randomized Control Trial of a Smartphone Application

OBJECTIVE

To determine whether parents of Very Low Birth Weight (VLBW) infants in the Neonatal Intensive Care Unit (NICU) transitioning home with the NICU-2-Home smartphone application have greater parenting self-efficacy, are better prepared for discharge and have shorter length of stay (LOS) than control parents.

METHODS

A four-week pilot randomized controlled trial during the transition home with 90 VLBW parents randomized to usual care (n=44) or usual care plus NICU-2-Home (n=46), a smartphone application designed for VLBW parents. Parenting Sense of Competence Scale (PSOC) was assessed at baseline, day after discharge, and two weeks post-discharge. Preparedness for discharge and length of stay (LOS) were secondary outcomes. Analyses by usage were also included.

RESULTS

While parents of VLBW infants in the intervention group did not show an improvement in PSOC during the transition when compared directly to controls, after accounting for actual mean app usage, PSOC improved 7% (2.71 points/time greater; 95%CI = 1.45, 6.27) for intervention versus controls. Compared to controls, above-average users increased their PSOC score by 14% (6.84 points/time; 95%CL = 5.02, 8.67), average users by 11% (4.58 points/time; 95%CL = 2.89, 6.27) and below-average users by 6% (2.41 points/time; 95%CL = 0.04, 4.79). Moderate evidence showed LOS was shorter for above-average users compared to the control group (β = 12.2. SE = 6.9, p = 0.085).

CONCLUSION

A smartphone application used by parents of VLBW infants during the transition home from the NICU can improve parenting self-efficacy, discharge preparedness, and LOS with improved benefits based on usage.

Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England

OBJECTIVE

To implement parent-oriented discharge planning (Train-to-Home) for preterm infants in neonatal care.

DESIGN

Before and after study, investigating the effects of the intervention during two 11-month periods before and after implementation.

SETTING

Four local neonatal units (LNUs) in South West England.

PARTICIPANTS

Infants without major anomalies born at 27-33 weeks' gestation admitted to participating units, and their parents.

TRAIN-TO-HOME INTERVENTION

A family-centred discharge package to increase parents' involvement and understanding of their baby's needs, comprising a train graphic and supporting care pathways to facilitate parents' understanding of their baby's progress and physiological maturation, combined with improved estimation of the likely discharge date.

MAIN OUTCOME MEASURES

Perceived Maternal Parenting Self-Efficacy (PMP S-E) scores, infant length of stay (LOS) and healthcare utilisation for 8 weeks following discharge.

RESULTS

Parents reported that the Train-to-Home improved understanding of their baby's progress and their preparedness for discharge. Despite a lack of change in PMP S-E scores with the intervention, the number of post-discharge visits to emergency departments (EDs) fell from 31 to 20 (p<0.05), with a significant reduction in associated healthcare costs (£3400 to £2200; p<0.05) after discharge. In both study phases, over 50% of infants went home more than 3 weeks before their estimated date of delivery (EDD), though no reduction in LOS occurred.

CONCLUSIONS

Despite the lack of measurable effect on the parental self-efficacy scores, the reduction in ED attendances and associated costs supports the potential value of this approach.

Preparing for Home: a before-and-after study to investigate the effects of a neonatal discharge package aimed at increasing parental knowledge, understanding and confidence in caring for their preterm infant before and after discharge from hospital

Background

Improved survival and shorter length of stay (LOS) for preterm infants, together with poorly organised discharge planning in some neonatal units, leaves many parents ill prepared to take their babies home, with increased use of out-of-hours services. Despite the importance accorded to family-orientated neonatal care by the Department of Health and the National Institute for Health and Care Excellence, few neonatal units offer structured, family-orientated discharge planning.

Objectives

To implement a parent-orientated discharge planning approach (Train-to-Home package) for preterm infants and investigate the effects on parental self-efficacy scores, infants’ LOS and change in costs associated with use of health-care resources in the 8 weeks after discharge, before and after implementation.

Design

A before-and-after study, investigating the effects of Train-to-Home package during two 11-month periods, immediately before and after its implementation.

Setting

Four local neonatal units in South West England.

Participants

Infants without major anomalies, born at 27–33 weeks’ gestation, admitted to the participating units, and their parents.

Train-to-Home intervention

A parent-orientated package that incorporated approaches to improving parents’ involvement in, and understanding of, their baby’s needs. It comprised a train graphic and supporting care pathways to facilitate parents’ understanding of their baby’s progress through the neonatal unit, combined with improved estimation, soon after hospital admission, of the baby’s likely discharge date.

Main outcome measures

Primary – Perceived Maternal Parenting Self-Efficacy (PMPS-E) scores before and after implementing the Train-to-Home package; secondary – infant LOS and health-care utilisation after discharge.

Results

We recruited 128 and 117 infants, respectively, in phase 1 (before implementation) and phase 2 (after implementation). In phase 2, parents reported improved understanding of babies’ progress, and preparedness for discharge, although PMPS-E scores did not change. The number of visits to emergency departments (EDs) fell from 31 in phase 1 to 20 in phase 2 (p < 0.05), with a significant reduction in associated health-care costs (from £3400 to £2200;p < 0.05) after hospital discharge. LOS did not change, but in both phases of the study > 50% of infants went home at > 3 weeks before their estimated date of delivery. Many nurses felt that the estimated discharge dates were over-optimistic, despite being based upon recent local data, and accurately predicting discharge dates for almost 75% of babies in the study.

Harms

No adverse consequences were identified.

Conclusions

The very early discharge of most babies made further shortening of LOS very difficult to achieve. Despite the lack of change of the parental self-efficacy scores, parents reported that their understanding and confidence in caring for their infants were improved by the Train-to-Home package, and the reduction in ED attendance and associated costs supports this assessment. The present study was limited by the tight time constraints for implementation, limited cascading of staff training and lack of staff confidence in the estimated dates of discharge.

Future work

Provision of the Train-to-Home package as a web-based system, allowing individual neonatal units and parents to access and use the materials, may allow more effective implementation in the future.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Transition From Hospital to Home in Parents of Preterm Infants: A Literature Review

Transition from hospital to home is a complex and multidimensional phenomenon for parents of prematurely born infants (<37 weeks of gestation). The absence of a clear conceptualization of this particular transition coupled with the challenges parents have when they return home and higher costs of healthcare service usage postdischarge dictates the need for a better understanding of this phenomenon. A literature review was undertaken using Whittemore and Knafl's theoretical framework for integrative review as a guide. A systematic search of the electronic databases (PsycINFO, PubMed, Medline, Cumulative Index of Nursing and Allied Health Literature, EMBASE, Cochrane Database for Systematic Reviews, and EBSCO) was performed. Fifty selected reports of research conducted on parents of preterm infants during 1980-2014 are included in this article. Five themes emerged from the review-disruption of parental role development, distorted development of parent-infant relationships, psychological consequences of a preterm birth and infant hospitalization, learning caregiving and parenting, and need for social and professional supports-which appear to reflect parental challenges during transition from hospital to home after discharge. Several inconsistencies in results of the studies dictate the need for further research in this vulnerable population; the better conceptualization and measurement of transitional challenges are warranted.