Recognizing and mitigating infant distress in Neonatal Intensive Care Unit (NICU)

Givrad, Soudabeh; Dowtin, LaTrice L.; Scala, Melissa; Hall, Sue

doi:10.1016/j.jnn.2020.09.009

Cited by 10 publications

(4 citation statements)

References 87 publications

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“…The stress exposures of NICU infants are consistent with the American Academy of Pediatrics' definition of toxic stress that includes stressor exposures that are repeated, severe, or prolonged and occur in the absence of buffering social relationships 18. Social relationships influence the neurodevelopment of NICU infants,19 with the most significant social relationships for infants being those with parents 20,21. Parent presence has been identified as a form of parent engagement in the NICU essential to the development and maintenance of parent–infant relationships, as it is during time spent in the NICU that parents interact with their infants 22,23.…”

Section: Background and Significancementioning

confidence: 71%

“…18 Social relationships influence the neurodevelopment of NICU infants, 19 with the most significant social relationships for infants being those with parents. 20,21 Parent presence has been identified as a form of parent engagement in the NICU essential to the development and maintenance of parent-infant relationships, as it is during time spent in the NICU that parents interact with their infants. 22,23 These interactions may include frequently documented caregiving activities such as skin-to-skin care (SSC) or in the moment touches and vocalizations in response to infant cues that are not documented or measured.…”

Section: Background and Significancementioning

confidence: 99%

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Impact of Parent Presence and Engagement on Stress in NICU Infants

Horner

2024

Advances in Neonatal Care

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Background: Infants in neonatal intensive care units (NICUs) are exposed to frequent stressors that impact their neurodevelopmental outcomes. Parent presence and engagement are considered critical to improving infant outcomes, yet associations between cumulative NICU parent presence, engagement, and infant stress are infrequently examined. Purpose: To examine associations between NICU infant stress and the amount (hours per week) or frequency (days per week) of parent presence and skin-to-skin care (SSC). Methods: A secondary analysis of a data set representing 78 NICU families was conducted. Infant acuity was measured using Neonatal Medical Index (NMI) scores. Parent presence and SSC data were collected from electronic medical records. Infant stress was measured using resting salivary cortisol levels collected at NICU discharge (median = 33 days of life). Results: More cumulative SSC was associated with lower discharge cortisol in NICU infants for SSC measured in hours per week (P = .03) or days per week (P = .05). Cumulative parent presence was not significantly associated with infant cortisol at discharge. Hierarchical regression analyses examining timing of parent presence supported a model including admission cortisol, NMI score, and parent presence during weeks 1 to 4 of life for explaining infant stress at discharge (R 2 = 0.44, P = .004). Analyses examining timing of SSC supported a model including admission cortisol, NMI score, and frequency of SSC during week 1 for explaining infant stress at discharge (R 2 = 0.21, P = .04). Implications for Practice and Research: Early, frequent SSC to mitigate stress in NICU infants was supported. Results suggested that timing of parent presence impacts NICU infant stress; however, additional study is recommended.

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Section: Background and Significancementioning

confidence: 71%

Section: Background and Significancementioning

confidence: 99%

Impact of Parent Presence and Engagement on Stress in NICU Infants

Horner

2024

Advances in Neonatal Care

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“…In addition to increased signs of trauma related to persistent stress, parents of infants requiring a NICU stay also experience increased levels of depression and anxiety [32,53]. Many NICUs have staff whose role is to support family mental health and assist families in accessing mental health resources upon discharge [54].…”

Section: Discussionmentioning

confidence: 99%

Parent Experiences in the NICU and Transition to Home

Spence

Stuyvenberg

Kane

et al. 2023

IJERPH

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Families (n = 12) with infants born at <29 weeks gestation shared their experiences while in the NICU and transitioning home. Parents were interviewed 6–8 weeks after NICU discharge, including some during the acute phase of the COVID-19 pandemic. Findings regarding the parent experience in the NICU were focused around challenges navigating parent-infant separation, social isolation, communication difficulties, limited knowledge of preterm infants, mental health challenges. Parents also discussed supports that were present and supports they wished were present, as well as the impact of COVID-19 on their experiences. In the transition to home, primary experiences included the sudden nature of the transition, anxiety around discharge preparation, and the loss of the support from nursing staff. During the first few weeks at home, parents expressed joy and anxiety, particularly around feeding. The COVID-19 pandemic limited emotional, informational, and physical support to parents and resulted in limited mutual support from other parents of infants in the NICU. Parents of preterm infants in the NICU present with multiple stressors, rendering attending to parental mental health crucial. NICU staff need to address logistical barriers and familial priorities impacting communication and parent-infant bonding. Providing multiple opportunities for communication, participating in caretaking activities, and meeting other families can be important sources of support and knowledge for parents of very preterm infants.

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“…A preterm baby in the NICU additionally affects the transition to parenthood and overwhelms parents with feelings, which frequently result in a sense of helplessness, psychological distress, anxiety and depressive symptoms. 8 9 Furthermore, compared with parents of healthy infants, it is thought that parents of infants admitted to a NICU face greater uncertainty. This uncertainty has been linked to many factors, such as adjusting to having a preterm baby, the stressful NICU environment, the physical and emotional isolation from the baby as well as the inability to protect the infant from pain.…”

Section: Introductionmentioning

confidence: 99%

Uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care unit among selected governmental hospitals in Addis Ababa, Ethiopia, 2022: an institution-based cross-sectional study

Tilahun,

Yilak,

Amena

et al. 2024

BMJ Open

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ObjectiveTo assess the uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care units of selected governmental hospitals in Addis Ababa, Ethiopia, 2022.DesignA cross-sectional study conducted from 3 March 2022 to 30 March 2022.SettingThe research was conducted at a government hospital in Addis Ababa, Ethiopia.ParticipantsOut of 305 eligible participants, 303 were parents of preterm infants’ participants with complete data.Primary outcome measureLevels of parental uncertainty, assessed by using the Mishel scale of uncertainty. Simple and multivariable linear regression analyses were conducted to assess associations between variables.ResultsThe mean uncertainty expressed by parents was 101.3 (SD=21.12). There were significant associations found with various factors. The sex of the respondent fathers (β=−4.65, 95% CI −9.32 to –0.025), length of neonatal intensive care unit (NICU) stay >10 days (β=14.64, 95% CI 8.71 to 20.56), gestational week between 34 and 37 weeks (β=−7.47, 95% CI −11.42 to –3.52), parents with college degrees and above (β=−14.15, 95% CI −22.94 to –5.34), parents with neonates who were preterm and had neonatal sepsis (β=10.42, 95% CI −17.57 to –3.27), parents without a history of neonatal NICU admission (β=−6.16, 95% CI −11.69 to –0.63) and parents who were housewives (β=6.51, 95% CI 1.83 to 12.19) all showed significant associations.ConclusionFactors like educational status, gestational week, neonatal admission history and NICU stay length contribute to parental uncertainty. Promoting empathy and clear communication is crucial. Hospitals should develop compassionate protocols for information delivery, including regular updates and effective addressing of concerns. Fostering a supportive environment helps parents express emotions and seek support.

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Recognizing and mitigating infant distress in Neonatal Intensive Care Unit (NICU)

Cited by 10 publications

References 87 publications

Impact of Parent Presence and Engagement on Stress in NICU Infants

Impact of Parent Presence and Engagement on Stress in NICU Infants

Parent Experiences in the NICU and Transition to Home

Uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care unit among selected governmental hospitals in Addis Ababa, Ethiopia, 2022: an institution-based cross-sectional study

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