An integrative review: maternal engagement in the neonatal intensive care unit and health outcomes for U.S.-born preterm infants and their parents

Abstract

Hospitals and perinatal organizations recognize the importance of family engagement in the neonatal intensive care unit (NICU). The Agency for Healthcare Research and Quality (AHRQ) defines family engagement as “A set of behaviors by patients, family members, and health professionals and a set of organizational policies and procedures that foster both the inclusion of patients and family members as active members of the health care team and collaborative partnerships with providers and provider organizations.” In-unit barriers and facilitators to enhance family engagement are well studied; however, less is known specifically about maternal engagement's influence in the NICU on the health of infants and mothers, particularly within U.S. social and healthcare contexts. In this integrative review, we examine the relationship between maternal engagement in the NICU and preterm infant and maternal health outcomes within the U.S. Results from the 33 articles that met inclusion criteria indicate that maternal engagement in the NICU is associated with infant outcomes, maternal health-behavior outcomes, maternal mental health outcomes, maternal-child bonding outcomes, and breastfeeding outcomes. Skin-to-skin holding is the most studied maternal engagement activity in the U.S. preterm NICU population. Further research is needed to understand what types of engagement are most salient, how they should be measured, and which immediate outcomes are the best predictors of long-term health and well-being.

Women’s experience of agency and respect in maternity care by type of insurance in California

“…[ 16 ] Engagement and patient activation have been associated with improvements in outcomes generally [ 17 , 18 ] and specifically in maternal and infant health. [ 19 ] We examined whether indicators of maternal agency, a concept that encompasses a sense of women’s control and autonomy, [ 20 , 21 ] differed by type of payer during prenatal, intrapartum and postpartum periods. Research comparing care of women with Medicaid and commercial coverage for maternity care generally reports on differences in use of interventions, with Medicaid beneficiaries less likely to experience cesarean birth overall, [ 22 – 25 ] or for specific diagnoses [ 26 ] or in one study experiencing no difference.…”

Experiences of Parents of Preterm Children Hospitalized Regarding Restrictions to Interact with Their Children Imposed Because of the COVID-19 Pandemic

“…Separation of the preterm children and their parents has negative effects at the physical and emotional levels and in the mental health of the parents and children. ( 14 ) The presence of the parents facilitates to the nursing staff the direct transference of information about the child’s care, but also permits establishing a relationship of trust,( 15 ) provide support, and identify the needs and possibilities of each parent to assume effectively the care of their children, which is determinant for the child’s health after discharge. Due to this, the virtual media used during the pandemic must be a means of emotional support and an educational setting that complements the limited spaces that allow the physical presence of the parents, which becomes a challenge for the nursing staff.…”

Disparities in Kangaroo Care for Premature Infants in the Neonatal Intensive Care Unit

“…While parents may not understand medical barriers to KC, disagreements or communication barriers between family and clinical staff only hamper efforts at family-centered care. Most national quality metrics used to gauge NICU care do not include direct measures of family-centered care; best family-centered care measures are still under discussion 52 . Clinical staff may interpret quality standards as stressing factors, such as equipment dislodgements like unplanned extubations, as more important than parent engagement in infant care.…”