Parental presence and holding in the neonatal intensive care unit and associations with early neurobehavior

Abstract

ObjectiveTo investigate the effects of parental presence and infant holding in the NICU on neurobehavior at term equivalent.Study DesignProspective cohort enrolled 81 infants born <30 weeks gestation. Nurses tracked parent visitation, holding, and skin-to-skin care throughout the NICU hospitalization. At term, the NICU Network Neurobehavioral Scale was administered. Associations between visitation, holding, and early neurobehavior were determined using linear and logistic regression.ResultsThe mean hours/week of parent visitation was 21.33±20.88 (median= 13.90; interquartile range 10.10–23.60). Infants were held an average of 2.29±1.47 days/week (median= 2.00; interquartile range 1.20–3.10). Over the admission, visitation hours decreased (p=0.01), while holding frequencies increased (p<0.001). More visitation was associated with better quality of movement (p=0.02), less arousal (p=0.01), less excitability (p=0.03), more lethargy (p=0.01) and more hypotonia (p<0.01). More holding was associated with improved quality of movement (p<0.01), less stress (p<0.01), less arousal (p=0.04) and less excitability (p<0.01).InterpretationInfants of caregivers who were visited and held more often in the NICU had differences in early neurobehavior by term equivalent, which supports increased early parenting in the NICU.

Prematuridade, Funções Executivas e Qualidade dos Cuidados Parentais: Revisão Sistemática de Literatura

“…As mães dessas crianças oscilavam entre sentimentos de esperança e desespero face à sobrevivência dos filhos, experienciando culpa quando da separação do bebê internado, como, por exemplo, ao voltar para casa, à noite. A meta-análise revelou ainda que as mães sentiam falta de privacidade com os seus bebês e o fato de terem que confiar os cuidados básicos às enfermeiras fazia-as temer pela futura vinculação com a criança.Também o tempo de hospitalização neonatal característico do nascimento prematuro representa um desafio à constituição de uma interação pais-criança precoce de qualidade (Reynolds et al, 2013), pela significativa obstrução ao cuidar e tocar na criança (Charpak et al, 2005). Essas condições intrínsecas ao nascimento prematuro promovem um elevado nível de estresse na família, que pode ser perturbador para a construção dos cuidados parentaise de um referencial de interação pais-criança.…”

Parent's support group as a transforming experience for families at a neonatal unit

“…The plans made until that point need to be rethought in order to be adjusted to the new reality 1 . In this circumstance, the parents express feelings of shock, denial, anger, frustration, guilt, depression, hopelessness, helplessness, loss, isolation, confusion and anxiety [1][2][3][4] which contribute to stress. Moreover, other elements linked to the characteristics of the neonatal environment contribute to parental stress as the change in the clinical conditions of the newborn, administrative rules and routines; barriers in the communication with the multidisciplinary team, and difficulty in building parenthood in a collective and unknown environment [2][3][4] .…”

“…In this circumstance, the parents express feelings of shock, denial, anger, frustration, guilt, depression, hopelessness, helplessness, loss, isolation, confusion and anxiety [1][2][3][4] which contribute to stress. Moreover, other elements linked to the characteristics of the neonatal environment contribute to parental stress as the change in the clinical conditions of the newborn, administrative rules and routines; barriers in the communication with the multidisciplinary team, and difficulty in building parenthood in a collective and unknown environment [2][3][4] . Receiving the family in this care environment, integrating them and discussing with them the best treatment procedures to be performed is essential so that emotional experiences that may occur during this period are worked and the stress and the suffering of the family can be alleviated 2,5,6 .…”

“…Moreover, other elements linked to the characteristics of the neonatal environment contribute to parental stress as the change in the clinical conditions of the newborn, administrative rules and routines; barriers in the communication with the multidisciplinary team, and difficulty in building parenthood in a collective and unknown environment [2][3][4] . Receiving the family in this care environment, integrating them and discussing with them the best treatment procedures to be performed is essential so that emotional experiences that may occur during this period are worked and the stress and the suffering of the family can be alleviated 2,5,6 . Thus, practices that bring families to participate in the care of the newborn, not only favor the emotional bond between parents and baby, but also are means to reduce stress, anxiety and fear caused by hospitalization.…”

“…To put into practice this new model, some interventions have been recommended and implemented in neonatal units of some institutions. Some of them are: encouraging the use of the kangaroo method, switching restrictive rules that keep the family away to other routines that include them, encouraging the visit of other family members, the permanent stay of parents with the hospitalized child, encouraging the participation of parents in the care of baby as well as in the decision making about the treatment and the implementation of spaces to listen the family in support groups, among others 2,5,8 . In the authors' experience with the use of the support group strategy since 2004, it is observed that in this space, it's possible to meet the emotional and social demands of the families; improve communication between family-staff; provide mechanisms for families to discuss and share their concerns; promote participation and autonomy of the family in care and make the preparation for discharge.…”