Paternal and Maternal Concerns for Their Very Low-Birth-Weight Infants Transitioning From the NICU to Home

Abstract

This study examines qualitatively the concerns and coping mechanisms of fathers and mothers of very low-birth-weight (VLBW; <1500 g) neonatal intensive care unit (NICU) infants as they transition to home from the NICU. In-depth, semistructured phone interviews were conducted with a sample of fathers and mothers of VLBW NICU infants in the Chicago area who had transitioned home, and parental concerns were examined during the transition to home. Phone interviews lasting 30 to 60 minutes were transcribed verbatim, and all interviews were coded using content and narrative analysis. Twenty-five parents (10 fathers, 15 mothers) of 16 VLBW infants who had an average gestational age of 29.5 weeks and an average NICU stay of 58.38 days completed the interview. Overriding concerns included pervasive uncertainty, lingering medical concerns, and partner-related adjustment concerns that differed by gender. A variety of resilient coping methods during this stressful transition are also described. Fathers and mothers of VLBW NICU graduates have evolving but often differing concerns as they transition from the NICU to home. Many of these concerns can be addressed with improved discharge information exchanges and anticipatory guidance. Supporting parents during this stressful and often difficult transition may lead to decreased family stress, improved care, and better infant outcomes.

Perspectives of Low Socioeconomic Status Mothers of Premature Infants

“…Stress about apnea of prematurity and transitioning out of a highly monitored NICU environment was a common theme in studies of higher-SES NICU parents and lower-SES Latino families, indicating that these concerns are highly generalizable and should be a high priority for any NICU. 16,17,32,33 This anxiety about infants' readiness for discharge and feeling unprepared can have consequences that may go unrecognized by NICU providers. Parental unreadiness for NICU discharge is associated with suboptimal communication with outpatient providers.…”

Incertezas dos pais de recém-nascidos internados: proposta de intervenção à luz da teoria de Mishel

“…17 Unpredictability, also called by Mishel as probabilistic thinking, was a factor that increased the uncertainty of the parents, bringing, also, concern emerging from the unknown and lack of control. 12,16,18 This situation is manifested, mainly, when there is clinical instability of the newborn, born, and mothers come to live with the uncertainty of life and the imminent risk of death, presenting feelings of sadness, anxiety and hopelessness. [11][12]18,[24][25] The typology of symptoms, described as the milestone in perceiving to what degree the symptoms are perceivable and happening, also contributed to the increase of uncertainties.…”

“…12,16,18 This situation is manifested, mainly, when there is clinical instability of the newborn, born, and mothers come to live with the uncertainty of life and the imminent risk of death, presenting feelings of sadness, anxiety and hopelessness. [11][12]18,[24][25] The typology of symptoms, described as the milestone in perceiving to what degree the symptoms are perceivable and happening, also contributed to the increase of uncertainties. The findings show the traumatic nature and psychological suffering related to prematurity, leading to the prolonged experience of uncertainty in some parents.…”

“…10,24 The findings reinforce the role of nurses in the involvement of parents in care and preparation for discharge , by encouraging touch and participation in care, favoring the parent / child bonding and the development of parental competences. 12,19 Mothers also managed to have their uncertainties diminished as they gained confidence in the health professional, and this was only possible after dialogue and reception of mothers by professionals. It is at this stage that necessary guidance on the environment, routines, and health status of the infant should be provided.…”

“…Support for parents leads to decreased family stress, decreased levels of uncertainty, and improved care for the child. 12 4 Describe how parents of premature infants experience transporting their baby from the neonatal intensive care unit of a university hospital (NICU-U) to a local hospital (NICU-L) . 13 The analysis of qualitative content resulted in one theme: living in uncertainty about whether the baby will survive, and three categories: being estranged from the baby; fear that something will happen to the baby during transportation and experience the closeness to the baby.…”