A global perspective on parental stress in the neonatal intensive care unit: a meta-analytic study

Caporali, Camilla; Pisoni, Camilla; Gasparini, Linda; Ballante, Elena; Zecca, Marzo; Orcesi, Simona; Provenzi, Livio

doi:10.1038/s41372-020-00798-6

Cited by 112 publications

(138 citation statements)

References 81 publications

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“…Positive parent-infant interactions have been demonstrated to buffer the connections between early neonatal pain in preterm infants and their subsequent cognitive functioning and mental health outcomes (6). However, parents of infants admitted to neonatal care experience a substantial amount of stress (7). One of the most stressful experiences for parents in the neonatal unit, along with the loss of their parental role, is the worry that their infant will suffer pain (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review

2021

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Introduction: Parents' active involvement during painful procedures is considered a critical first step in improving neonatal pain practices. Of the non-pharmacological approaches in use, the biopsychosocial perspective supports parent-delivered interventions, in which parents themselves mediate pain relief, consistent with modern family-integrated care. This scoping review synthesizes the available research to provide an overview of the state of the art in parent-delivered pain-relieving interventions.Methods: A scoping review was performed to achieve a broad understanding of the current level of evidence and uptake of parent-driven pain- and stress-relieving interventions in neonatal care.Results: There is a strong evidence for the efficacy of skin-to-skin contact and breastfeeding, preferably in combination. These parent-delivered interventions are safe, valid, and ready for prompt introduction in infants' pain care globally. Research into parents' motivations for, and experiences of, alleviating infant pain is scarce. More research on combined parent-delivered pain alleviation, including relationship-based interventions such as the parent's musical presence, is needed to advance infant pain care. Guidelines need to be updated to include infant pain management, parent-delivered interventions, and the synergistic effects of combining these interventions and to address parent involvement in low-income and low-tech settings.Conclusions: A knowledge-to-practice gap currently remains in parent-delivered pain management for infants' procedure-related pain. This scoping review highlights the many advantages of involving parents in pain management for the benefit not only of the infant and parent but also of health care.

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Section: Introductionmentioning

confidence: 99%

State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review

2021

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“…25 It is recommended that NICU-related parental stress be treated with immediate and tailored support provided to parents after the birth of a high-risk infant in order to reduce stress and improve well-being and infant neurodevelopmental outcomes. 8 Families and HCPs have identified that the tools to address a family's medical and social needs must extend beyond the NICU to include the transition to home 7 16-19 26-28 and first year of life. 13 23 29 Integrated healthcare models can support transition from hospital to home by decreasing parental stress, optimising family empowerment, and improving healthcare system efficiency 30 and costs.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…These infants are at risk of medical, cognitive and developmental sequelae. [2][3][4][5] Having an infant admitted to the NICU is associated with increased parental stress due to the NICU environment, alterations in parental role and limitations to caregiving, [6][7][8] as well as anxiety 9 10 and depression. [11][12][13] These emotions increase during the transition to home from hospital, [14][15][16] depending on the child's condition and the parent's readiness…”

Section: Introductionmentioning

confidence: 99%

Coached, Coordinated, Enhanced Neonatal Transition (CCENT): protocol for a multicentre pragmatic randomised controlled trial of transition-to-home support for parents of high-risk infants

et al. 2021

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IntroductionHaving an infant admitted to the neonatal intensive care unit (NICU) is associated with increased parental stress, anxiety and depression. Enhanced support for parents may decrease parental stress and improve subsequent parent and child outcomes. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) programme is a novel bundled intervention of psychosocial support delivered by a nurse navigator that includes Acceptance and Commitment Therapy-based coaching, care coordination and anticipatory education for parents of high-risk infants in the NICU through the first year at home. The primary objective is to evaluate the impact of the intervention on parent stress at 12 months.Methods and analysisThis is a multicentre pragmatic randomised controlled superiority trial with 1:1 allocation to the CCENT model versus control (standard neonatal follow-up). Parents of high-risk infants (n=236) will be recruited from seven NICUs across three Canadian provinces. Intervention participants are assigned a nurse navigator who will provide the intervention for 12 months. Outcomes are measured at baseline, 6 weeks, 4, 12 and 18 months. The primary outcome measure is the total score of the Parenting Stress Index Fourth Edition Short Form at 12 months. Secondary outcomes include parental mental health, empowerment and health-related quality of life for calculation of quality-adjusted life years (QALYs). A cost-effectiveness analysis will examine the incremental cost of CCENT versus usual care per QALY gained. Qualitative interviews will explore parent and healthcare provider experiences with the intervention.Ethics and disseminationResearch ethics approval was obtained from Clinical Trials Ontario, Children’s Hospital of Eastern Ontario Research Ethics Board (REB), The Hospital for Sick Children REB, UBC Children’s and Women’s REB and McGill University Health Centre REB. Results will be shared with Canadian level III NICUs, neonatal follow-up programmes and academic forums.Trial registration numberClinicalTrials.gov Registry (NCT03350243).

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“…Active parent participation in neonatal care during infant hospitalization in the neonatal intensive care unit (NICU) can ameliorate adverse outcomes for infants and their parents [1][2][3][4][5][6][7]. Through parent participation in neonatal care, parents can be a central part of the NICU care team, gain confidence in taking care of their infant, and prepare themselves for discharge [8,9].…”

Section: Introductionmentioning

confidence: 99%

Development and psychometric evaluation of the CO-PARTNER tool for collaboration and parent participation in neonatal care

et al. 2021

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Background Active parent participation in neonatal care and collaboration between parents and professionals during infant hospitalization in the neonatal intensive care unit (NICU) is beneficial for infants and their parents. A tool is needed to support parents and to study the effects and implementation of parent-partnered models of neonatal care. Methods We developed and psychometrically evaluated a tool measuring active parent participation and collaboration in neonatal care within six domains: Daily Care, Medical Care, Acquiring Information, Parent Advocacy, Time Spent with Infant and Closeness and Comforting the Infant. Items were generated in focus group discussions and in-depth interviews with professionals and parents. The tool was completed at NICU-discharge by 306 parents (174 mothers and 132 fathers) of preterm infants. Subsequently, we studied structural validity with confirmatory factor analysis (CFA), construct validity, using the Average Variance Extracted and Heterotrait-Monotrait ratio of correlations, and hypothesis testing with correlations and univariate linear regression. For internal consistency we calculated composite reliability (CR). We performed multiple imputations by chained equations for missing data. Results A 31 item tool for parent participation and collaboration in neonatal care was developed. CFA revealed high factor loadings of items within each domain. Internal consistency was 0.558 to 0.938. Convergent validity and discriminant validity were strong. Higher scores correlated with less parent depressive symptoms (r = -0.141, 95%CI -0.240; -0.029, p = 0.0141), less impaired parent-infant bonding (r = -0.196, 95%CI -0.302; -0.056, p<0.0001), higher parent self-efficacy (r = 0.228, 95%CI 0.117; 0.332, p<0.0001), and higher parent satisfaction (r = 0.197, 95%CI 0.090; 0.308, p = 0.001). Parents in a family integrated care model had higher scores than in standard care (beta 6.020, 95%CI 4.144; 7.895, p<0.0001) and mothers scored higher than fathers (beta 2.103,95%CI 0.084; 4.121, p = 0.041). Conclusion The CO-PARTNER tool explicitly measures parents’ participation and collaboration with professionals in neonatal care incorporating their unique roles in care provision, leadership, and connection to their infant. The tool consists of 31 items within six domains with good face, content, construct and structural validity.

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A global perspective on parental stress in the neonatal intensive care unit: a meta-analytic study

Cited by 112 publications

References 81 publications

State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review

State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review

Coached, Coordinated, Enhanced Neonatal Transition (CCENT): protocol for a multicentre pragmatic randomised controlled trial of transition-to-home support for parents of high-risk infants

Development and psychometric evaluation of the CO-PARTNER tool for collaboration and parent participation in neonatal care

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