A framework synthesis reviewing the impact of neonatal care unit admission on early caregiver–infant relationships

Abstract

Aims To critically review and synthesize qualitative research pertaining to the establishment of early caregiver–infant relationships in the neonatal care unit (NCU). Background It is well‐established that bonding and attachment, established across the prenatal and early childhood periods, affect child cognitive and behavioural development. Proximity, reciprocity, and commitment are key to the formation of these early relationships. It is intuitively likely that an admission to the NCU may affect early reciprocal caregiver–infant relationships. Design A qualitative best‐fit framework synthesis. Data sources A systematic search of four databases (PsycINFO, MEDLINE, British Nursing Index and CINAHL) was conducted, from January 2000–December 2018. Review Methods The RATS quality appraisal tool was used to evaluate study quality. To ensure reliability, 20% of studies were randomly selected for independent rating. A “best‐fit” synthesis approach using an existing framework of early parent–infant attachment and bonding was adopted to synthesize the review findings. Findings Twenty studies, from an original 3,526 unique articles, were included in the review. Studies varied in the extent to which they demonstrated transparency of procedures and in the quality of recruitment information provided. The meta‐synthesis demonstrated that proximity, reciprocity, and commitment were affected by admission to a NCU and identified that parental reflections on bonding and the role of staff in this process, were important factors to consider. Conclusions Caregiver–infant relationships are affected by admission to the NCU. The review theoretically supports moves to Family Integrated Care. Units should evaluate caregiver emotional state and consider the role of peer support. Impact The synthesis revealed that areas typically implicated in the formation of attachment and bonds were affected by admission to a NCU. Results have implications on the clinical care delivered as part of neonatal care.

Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks—A Qualitative Descriptive Study

“…The parents in our study emphasised the support they had experienced provided by the NICU staff and sometimes even other NICU parents. The importance of the support by neonatal unit staff has been stated in several qualitative studies [14]. According to the mothering theory of psychologist Daniel Stern [31], new mothers do not only need advice but also a positive psychological holding condition that lets them to feel free to explore and find their natural maternal behaviour.…”

“…Several qualitative studies have identified obstacles preventing healthy bonding in the NICU in mothers of premature infants: the medical environment, separation, lack of parental participation, and the fear of losing their infant [14]. Mothers often struggle with difficult emotions such as failure and guilt that further complicate the bonding process and maternal role formation [15][16][17].…”

“…Mothers often struggle with difficult emotions such as failure and guilt that further complicate the bonding process and maternal role formation [15][16][17]. Moreover, in cases where mothers are afraid that their premature child might die, they tend to distance themselves emotionally and do not let themselves become attached to the child [14,16,18]. NICU fathers, although less studied, have been reported to struggle with feelings of helplessness and being out of control [19], thus acting as barriers to participating in the infant's care, and the lack of physical contact with the infant signal a significant risk for healthy bonding with their child.…”

Predictive role of NICU‐related stress, postpartum depression trajectory and family coping on growth trajectory of moderate‐to‐late preterm infants: A longitudinal study

“…NICU stay following the birth of MLPIs is stressful. The NICU environment leads preterm infants to adverse effects on their cognitive, motor, socio‐emotional development and regulatory functions (Carton et al., 2020; Johnson & Marlow, 2017). They are exposed to clinically required monitoring, skin‐breaking procedures, excessive exposure to noise and light, discomfort positioning and prolonged mechanical ventilation.…”