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Very preterm birth: maternal experiences of the neonatal intensive care environment

Journal of Perinatology volume 34, pages 555–561 (2014)Cite this article

Subjects

Abstract

Objective:

Examine sources, predictors and child outcomes associated with neonatal intensive care unit (NICU)-related stress for mothers of infants born very preterm (VPT).

Study Design:

Participants were 133 mothers of VPT infants admitted to a regional level-III NICU. At term equivalent, mothers completed the Parental Stressor Scale: NICU and were interviewed about their psychological well-being and family circumstances. Infant clinical data were also collected. At corrected age 4 years, 49 children were assessed for cognition, language and socio-emotional development.

Result:

Mothers reported moderate to low stress, with parental role alteration considered most stressful and parent–staff communications least stressful. Predictors of overall stress included maternal educational underachievement, stressful life events, postnatal depression and infant unsettled-irregular behavior. NICU-related stress was associated with child anxiety and poorer language development.

Conclusion:

Parental well-being is an important focus of care in the neonatal setting. Strategies are needed to optimize early engagement and reduce stress levels to assist improved child outcomes.

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References

  1. Holditch-Davis D, Miles MS . Mothers' stories about their experiences in the neonatal intensive care unit. Neonatal Netw 2000; 19 (3): 13–21.

    Article  CAS  Google Scholar 

  2. Schappin R, Wijnroks L, Uniken Venema MM, Jongmans MJ . Rethinking stress in parents of preterm infants: a meta-analysis. PLoS One 2013; 8 (2): e54992.

    Article  CAS  Google Scholar 

  3. Aucott S, Donohue PK, Atkins E, Allen MC . Neurodevelopmental care in the NICU. Ment Retard Dev Disabil Res Rev 2002; 8 (4): 298–308.

    Article  Google Scholar 

  4. Clark CA, Woodward LJ, Horwood LJ, Moor S . Development of emotional and behavioral regulation in children born extremely preterm and very preterm: biological and social influences. Child Dev 2008; 79 (5): 1444–1462.

    Article  Google Scholar 

  5. Frye RE, Malmberg B, Swank P, Smith K, Landry S . Preterm birth and maternal responsiveness during childhood are associated with brain morphology in adolescence. J Int Neuropsychol Soc 2010; 16 (5): 784–794.

    Article  Google Scholar 

  6. Poehlmann J, Fiese BH . Parent-infant interaction as a mediator of the relation between neonatal risk status and 12-month cognitive development. Infant Behav Dev 2001; 24 (2): 171–188.

    Article  Google Scholar 

  7. Treyvaud K, Anderson VA, Lee KJ, Woodward LJ, Newnham C, Inder TE et al. Parental mental health and early social-emotional development of children born. J Pediatr Psychol 2010; 35 (7): 768–777.

    Article  Google Scholar 

  8. Singer LT, Salvator A, Guo S, Collin M, Lilien L, Baley J . Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA 1999; 281 (9): 799–805.

    Article  CAS  Google Scholar 

  9. Kersting A, Dorsch M, Wesselmann U, Lüdorff K, Witthaut J, Ohrmann P et al. Maternal posttraumatic stress response after the birth of a very low-birth-weight infant. J Psychosom Res 2004; 57 (5): 473–476.

    Article  CAS  Google Scholar 

  10. Obeidat HM, Bond EA, Callister LC . The parental experience of having an infant in the newborn intensive care unit. J Perinat Educ 2009; 18 (3): 23–29.

    Article  Google Scholar 

  11. Shields-Poë D, Pinelli J . Variables associated with parental stress in neonatal intensive care units. Neonatal Netw 1997; 16 (1): 29–37.

    PubMed  Google Scholar 

  12. Miles MS, Funk SG, Kasper MA . The neonatal intensive care unit environment: sources of stress for parents. AACN Clin Issues Crit Care Nurs 1991; 2 (2): 346–354.

    Article  CAS  Google Scholar 

  13. Doering LV, Moser DK, Dracup K . Correlates of anxiety, hostility, depression, and psychosocial adjustment in parents of NICU infants. Neonatal Netw 2000; 19 (5): 15–23.

    Article  CAS  Google Scholar 

  14. Cronin CM, Shapiro CR, Casiro OG, Cheang MS . The impact of very low-birth-weight infants on the family is long lasting. A matched control study. Arch Pediatr Adolesc Med 1995; 149 (2): 151–158.

    Article  CAS  Google Scholar 

  15. Montirosso R, Provenzi L, Calciolari G, Borgatti R . Group N-AS. Measuring maternal stress and perceived support in 25 Italian NICUs. Acta Paediatr 2012; 101 (2): 136–142.

    Article  Google Scholar 

  16. Woodward LJ, Clark CA, Bora S, Inder TE . Neonatal white matter abnormalities an important predictor of neurocognitive outcome for very pretermchildren. PLoS One 2012; 7 (12): e51879.

    Article  CAS  Google Scholar 

  17. Woodward LJ, Moor S, Hood KM, Champion PR, Foster-Cohen S, Inder TE et al. Very preterm children show impairments across multiple neurodevelopmental domains by age 4 years. Arch Dis Child Fetal Neonatal Ed 2009; 94 (5): F339–F344.

    Article  CAS  Google Scholar 

  18. Miles MS, Funk SG, Carlson J . Parental Stressor Scale: neonatal intensive care unit. Nurs Res 1993; 42 (3): 148–152.

    Article  CAS  Google Scholar 

  19. Franck LS, Cox S, Allen A, Winter I . Measuring neonatal intensive care unit-related parental stress. J Adv Nurs 2005; 49 (6): 608–615.

    Article  Google Scholar 

  20. Brazelton TB, Nugent JK . Neonatal Behavioral Assessment Scale, 3rd edn, vol. 137. Mac Keith Press: London, 1995.

    Google Scholar 

  21. Cox JL, Holden JM, Sagovsky R . Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150: 782–786.

    Article  CAS  Google Scholar 

  22. Navarro P, Ascaso C, Garcia-Esteve L, Aguado J, Torres A, Martín-Santos R . Postnatal psychiatric morbidity: a validation study of the GHQ-12 and the EPDS as screening tools. Gen Hosp Psychiatry 2007; 29 (1): 1–7.

    Article  Google Scholar 

  23. Holmes TH, Rahe RH . The Social Readjustment Rating Scale. J Psychosom Res 1967; 11 (2): 213–218.

    Article  CAS  Google Scholar 

  24. Elley WB, Irving JC . The Elley-Irving Socio-Economic Index: 2001 census revision. New Zeal J Educ Stud 2003; 38: 3–17.

    Google Scholar 

  25. Wechsler Preschool and Primary Scale of Intelligence-Revised. The Psychological Corporation: San Antonio, TX, 1989.

  26. Wiig EH, Secord W, Semel E . Clinical Evaluation of Language Fundamentals–Preschool: Examiner’s Manual. The Psychological Corporation: New York, 1992.

    Google Scholar 

  27. Goodman R . The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 1997; 38 (5): 581–586.

    Article  CAS  Google Scholar 

  28. Wereszczak J, Miles MS, Holditch-Davis D . Maternal recall of the neonatal intensive care unit. Neonatal Netw 1997; 16 (4): 33–40.

    CAS  PubMed  Google Scholar 

  29. Affonso DD, Hurst I, Mayberry LJ, Haller L, Yost K, Lynch ME . Stressors reported by mothers of hospitalized premature infants. Neonatal Netw 1992; 11 (6): 63–70.

    CAS  PubMed  Google Scholar 

  30. van der Pal SM, Maguire CM, le Cessie S, Wit JM, Walther FJ, Bruil J . Parental experiences during the first period at the neonatal unit after two developmental care interventions. Acta Paediatr 2007; 96 (11): 1611–1616.

    Article  CAS  Google Scholar 

  31. Fleisher BE, VandenBerg K, Constantinou J, Heller C, Benitz WE, Johnson A et al. Individualized developmental care for very-low-birth-weight premature infants. Clin Pediatr (Phila) 1995; 34 (10): 523–529.

    Article  CAS  Google Scholar 

  32. Turan T, Başbakkal Z, Ozbek S . Effect of nursing interventions on stressors of parents of premature infants in neonatal intensive care unit. J Clin Nurs 2008; 17 (21): 2856–2866.

    Article  Google Scholar 

  33. Als H, Gilkerson L, Duffy FH, McAnulty GB, Buehler DM, Vandenberg K et al. A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects. J Dev Behav Pediatr 2003; 24 (6): 399–408.

    Article  Google Scholar 

  34. Brazelton T, Cramer B . The Earliest Relationship: Parents, Infants and the Drama of Early Attachment. Karnac Books, 2012.

    Google Scholar 

  35. Ichijima E, Kirk R, Hornblow A . Parental support in neonatal intensive care units: a cross-cultural comparison between New Zealand and Japan. J Pediatr Nurs 2011; 26 (3): 206–215.

    Article  Google Scholar 

  36. Apter-Levy Y, Feldman M, Vakart A, Ebstein RP, Feldman R . Impact of maternal depression across the first 6 years of life on the child's mental health, social engagement, and empathy: the moderating role of oxytocin. Am J Psychiatry 2013; 170 (10): 1161–1168.

    Article  Google Scholar 

  37. Giallo R, Cooklin A, Wade C, D'Esposito F, Nicholson JM . Maternal postnatal mental health and later emotional-behavioural development of children: the mediating role of parenting behaviour. Child Care Health Dev 2013 (doi:10.1111cch.12028).

  38. Topol D, Girard N, Pierre L St, Tucker R, Vohr B . The effects of maternal stress and child language ability on behavioral outcomes of children with congenital hearing loss at 18-24months. Early Hum Dev 2011; 87 (12): 807–811.

    Article  Google Scholar 

  39. Quittner AL, Barker DH, Cruz I, Snell C, Grimley ME, Botteri M et al. Parenting stress among parents of deaf and hearing children: associations with language delays and behavior problems. Parent Sci Pract 2010; 10 (2): 136–155.

    Article  Google Scholar 

  40. Welch MG, Hofer MA, Brunelli SA, Stark RI, Andrews HF, Austin J et al. Family nurture intervention (FNI): methods and treatment protocol of a randomized controlled trial in the NICU. BMC Pediatr 2012; 12: 14.

    Article  Google Scholar 

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Acknowledgements

This study was supported by grants from the Neurological Foundation of New Zealand (reference number: 0012/PG; 022/PG), the Health Research Council of New Zealand (reference number: 03/196), the Lottery Grants Board of New Zealand (reference number: AP84691) and the Washington University Intellectual and Developmental Disabilities Research Center (reference number: NIH/NICHD P30 HD062171). Special thanks to Dr Alessandra Raudino for her biostatistical advice and also to Michelle Davey, Jacqueline Ware and Dr Kelly Hood for their assistance with data collection. Most importantly, we would like to thank the families who supported and generously gave their time, free of charge, to the study.

Author information

Authors and Affiliations

  1. Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,

    L J Woodward & S Bora

  2. Department of Psychology, University of Canterbury, Christchurch, New Zealand

    L J Woodward & A Montgomery-Hönger

  3. Department of Psychology, Prevention Science Institute, University of Oregon, OR, USA

    C A C Clark

  4. Department of Psychology, Aberystwyth University, Ceredigion, Wales, UK

    V E Pritchard

  5. Neonatal Service, Christchurch Women’s Hospital, Christchurch, New Zealand

    C Spencer & N C Austin

  6. Department of Pediatrics, University of Otago, Christchurch, New Zealand

    N C Austin

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  1. L J Woodward
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  2. S Bora
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  3. C A C Clark
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  4. A Montgomery-Hönger
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  7. N C Austin
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Correspondence to L J Woodward.

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The authors declare no conflict of interest.

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Woodward, L., Bora, S., Clark, C. et al. Very preterm birth: maternal experiences of the neonatal intensive care environment. J Perinatol 34, 555–561 (2014). https://doi.org/10.1038/jp.2014.43

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