Benefits of Infant Massage for Infants and Parents in the NICU

Infant massage is an ancient therapeutic technique used around the world. For infants who experience painful procedures, are exposed to the stressful NICU environment, and are separated from their parents, infant massage has been promoted as a method to reduce stress and promote bonding. In this article, we review the current literature on infant massage in the NICU. There is evidence that infant massage has beneficial effects on preterm infants in the NICU, including shorter length of stay; reduced pain; and improved weight gain, feeding tolerance, and neurodevelopment. Parents who performed massage with their infants in the NICU reported experiencing less stress, anxiety, and depression. Neonatal nurses can obtain education and certification in infant massage and can teach parents infant massage techniques, thereby promoting the health and well-being of parent–infant dyads.     

Improving mental health outcomes of parents of infants treated in neonatal intensive care units: A scoping review

Parents of infants who require neonatal intensive care unit (NICU) hospitalization encounter stressors that place them at a higher risk of developing a mental health issue during and after NICU discharge. This population is often underdiagnosed, leading to potential detrimental effects on parenting behaviours, parent/infant bonding, and child neurodevelopment. This review explores what mental health issues parents experience during and after NICU discharge, what mental health resources are currently available, what mental health screening tools are used, and what factors place NICU parents at an increased risk of developing a mental health issue. The review revealed that mental health issues are not isolated; if a parent experiences psychological distress, it can progress to depression or post-traumatic stress disorder (PTSD) if left untreated. Psychotherapy most frequently contributed to a reduction in mental health symptoms, but was rarely offered beyond NICU discharge.     

Case-control study of postpartum anxiety and maternal-infant bonding in NICU and non-NICU mothers

BackgroundImpaired maternal-infant bonding may affect negatively both the mother and her infant.AimTo investigate and compare the postnatally anxiety symptoms and the mother-infant bonding in NICU and non-NICU mothers.MethodsParticipants who gave birth at a Greek perinatal facility completed questionnaires, the Postpartum Bonding Questionnaire (PBQ) and the Hospital Anxiety and Depression Scale (HADS).ResultsThere was a statistically significant difference between the mean PBQ scores of NICU mothers and the control group. It was found that the control group expressed a better relationship with the newborn compared to the cases (t = ?3.126, p = 0.002). Cases had higher scores on HADS ratings than the control group (χ² = 12.366, p = 0.002). The anxiety scores were correlated with bonding scores in both groups.ConclusionsMothers of NICU infants have been shown to be more susceptible than mothers of healthy newborns. The NICU staff's support of these women and the fostering of mother-infant bonding, are critical.     

Implementation of a simulation-based education for mothers in managing respiratory emergencies in the neonatal intensive care unit

Neonatal Intensive Care Unit (NICU) discharge often causes concern for mothers since they are solely responsible for the care and safety of their infants. This study assesses the feasibility of simulation-based education on managing respiratory emergencies for mothers and investigates changes in mothers' confidence. It used a pilot one-group pre- and post-test design in an NICU. The general estimation equation was used to analyze the effects of simulation-based education and factors affecting mothers' confidence. The simulation-based education increased mothers' confidence in managing respiratory emergencies, and these effects continuedeven after discharge. Mothers with multiple pregnancies and mothers of infants with low birth weight, long gestation, and NICU stays showed increased confidence compared to their counterparts. Teaching using a simulation approach is feasible and significantly improves mothers' confidence in infants’ respiratory emergency management. The findings demonstrate the feasibility of simulation-based education in terms of clinical education for improving infant health outcomes.     

Parents' perceptions of their infant's pain experience in the NICU

Despite numerous advances in the recognition, assessment, and management of pain in neonates over the past two decades, there has been limited improvement in the knowledge base regarding parental responses to their infant's pain. This study examined parents' views of their experiences observing and coping with their infant's pain in the neonatal intensive care unit (NICU). Twelve participants were recruited using purposive sampling from two groups: (a) parents who had infants currently receiving care in the NICU (n=6); and (b) parents whose infants had been discharged from the NICU and were enrolled in the outpatient follow-up clinic at each hospital (n=6). An exploratory, semi-structured format was used to interview parents individually (n=5) or in focus groups (n=7) regarding their infant's clinical course, infant pain experiences, and the parenting experience during and after the NICU stay. Thematic content analysis was used to develop conceptual categories. Two broad themes were identified: (a) infant pain as a source of parental distress and (b) relief of parental distress due to infant's pain.     

Bereaved Parents' Perceptions of Infant Suffering in the NICU

ContextIt is challenging to provide supportive intensive care to infants in the neonatal intensive care unit (NICU), giving them every chance for survival, while also trying to minimize suffering for both the infant and parents. Parents who believe their infant is suffering may alter treatment goals based on their perceptions; however, it is unknown how parents come to believe that their infant may be suffering.ObjectivesTo examine bereaved parents' perceptions of infant suffering in the NICU.MethodsParents completed a qualitative interview exploring their perceptions of the level of suffering that their infant experienced at the end of life. Parents whose infant died in a large Midwestern Level IV regional referral NICU from July 2009 to July 2014 were invited to participate. Thirty mothers and 16 fathers from 31 families (31 of 249) participated in telephone interviews between three months and five years after their infant's death.ResultsFour themes emerged from the qualitative analysis: 1) the presence/absence of suffering, 2) indicators of suffering, 3) temporal components of suffering (trajectory), and 4) influence of perceived suffering on parents, infants, and clinical decision making.ConclusionParents used signs exhibited by infants, as well as information they received from the health care team to form their perceptions of suffering. Perceived suffering followed different trajectories and influenced the decisions that parents made for their infant. Soliciting parent perspectives may lead to improvements in the understanding of infant well-being, particularly suffering, as well as how parents rely on these perceptions to make treatment decisions for their infant.     

个体化护理服务模式对新生儿重症监护室早产儿预后的影响

目的探讨个体化护理服务模式对新生儿重症监护室(NICU)早产儿预后的影响。方法选取2017年1月至2019年2月入住该院NICU诊治的早产儿150例作为研究对象,根据入院先后顺序分为个体组(75例)和对照组(75例)。对照组早产儿给予常规护理,个体组在对照组护理的基础上给予个体化护理服务模式干预,记录与调查两组早产儿的预后。结果个体组早产儿护理1个月和3个月后的体质量与身长均明显高于对照组,差异均有统计学意义(P<0.05)。个体组早产儿护理3个月后的智力发育指数与心理运动发育指数评分均明显高于对照组,差异均有统计学意义(P<0.05)。两组早产儿护理3个月后的行为神经评分量表评分均明显高于护理前,并且个体组评分明显高于对照组,差异均有统计学意义(P<0.05)。个体组早产儿护理期间的再住院率为1.3%,明显低于对照组的10.7%,差异有统计学意义(P<0.05)。结论个体化护理服务模式在NICU早产儿中的应用能促进其生长发育,加快早产儿的神经发育与智力发育,降低再住院率。     

重症监护室中高危新生儿的听力检测研究

目的 研究新生儿重症监护室（NICU）中高危新生儿听力障碍发生的情况，探讨与听力障碍发生有关的高危因素。方法 采用畸变产物耳声发射（DPOAE）对NICU中高危新生儿进行听力筛查，未通过者进行复筛，复筛未通过者行听觉脑干反应（ABR）确诊检查；选取普通肺炎患儿作为对照。结果 检测NICU中172例高危新生儿，初筛异常62例，占36％；复筛62例，异常10例，占16．1％；3～4月龄时行ABR检查，确诊听力障碍5例，高危新生儿听力障碍发生率为2．91％。对照组检查普通肺炎患儿52例，初筛异常3例，占5．8％；3例复筛全部通过。结论 NICU中高危新生儿是听力障碍发生的高危人群，缺氧缺血性脑病、先天性CMV感染、新生儿败血症是发生听力障碍的危险因素。对高危新生儿应进行随访。     

Part 1: Narrative overview of developmental care interventions for the preterm newborn

The development of synaptic connections in the foetus' brain peaks during the third trimester of gestation. In case of preterm birth, the infant is vulnerable in the neonatal intensive care unit because of its immature and rapidly developing neurologic system. Therefore, developmental care interventions (DCI) are particularly important during the NICU hospitalization to optimize short and long-term outcomes, as well as neurodevelopment, in infants born prematurely. The aim of this article is to provide a narrative overview by summarizing findings of a thorough literature review on the latest findings regarding the effectiveness of six DCI on preterm infant's outcomes such as sleep, stress and neurodevelopment. Various DCI have been evaluated in empirical studies. Research related to these interventions is rapidly evolving but is still a priority in the neonatal research field.     

Parenting the NICU infant: A meta-ethnographic synthesis

Parenting the infant in the neonatal intensive care unit (NICU) comes with a multitude of unique challenges, and NICU parents are often unprepared and ill equipped for the challenges. Moreover, a gap in the literature still exists concerning a full understanding of the breadth of the process parents of NICU infants undergo from the time of admission to discharge. This study utilized Noblit and Hare's meta-ethnography synthesis method for literature extraction and data analysis to illuminate the NICU parenting process by metaphorically comparing the process to Patricia Benner's novice to expert theory. Fourteen studies including 12 published qualitative research articles and 2 dissertations from the nursing discipline were included in the analysis. Findings illuminated the process of becoming a NICU parent more fully and revealed the most salient and effective facilitators of the process from being a novice and advanced beginner to becoming a competent, proficient, even expert NICU parent. In addition, this paper discusses four influencing factors in a NICU parent's progression: contact with and proximity to their infant, relationship with the nurse, having information, and social support. Nurses must engage with NICU parents in such a way as to maximize the likelihood that these parents will reach at minimum the proficient and at maximum the expert parenting stage by discharge.     

Maternal cocaine abuse and fetal anomalies: evidence for teratogenic effects of cocaine

We have reported the case of an infant exposed prenatally to cocaine who had congenital anomalies, adding to the growing evidence suggesting cocaine's potential for teratogenicity. The infant, born at 36 weeks' gestation, had bilateral asymmetric upper limb amputation defects. The mother had moderate to severe uterine bleeding during the second trimester of pregnancy after she used intravenous cocaine. We hypothesize that the infant's anomalies are due to cocaine embryopathy, which resulted in amnion rupture or vascular disruption. We believe that cocaine embryopathy should be considered in the differential diagnosis of infants with congenital anomalies such as limb amputation defects.     

Nurses' expectations of using music for premature infants in neonatal intensive care unit

This study aimed to describe nurses' expectations of using music for premature infants in the neonatal intensive care unit (NICU) and to find out about the related background factors. The subjects consisted of 210 Finnish nurses who were recruited from the country's five university hospitals providing premature infant care in NICU. The data were collected by validated questionnaire, and the response rate was 82%. Most nurses preferred recorded music to live music in the NICU. They expected that music would have positive effects on premature infants, parents, and staff. Few demographic and many background factors of the respondents' music-related experiences correlated significantly with the expectations concerning their preference. In conclusion, the nurses' expectations were positive regarding the use of music in the NICU, which supports evidence regarding the efficacy of music therapy for premature infants.     

以家庭为中心的NICU早产儿出院指导对早产儿家庭护理的影响

目的探讨以家庭为中心的NICU早产儿出院指导对早产儿家庭护理的影响。方法选择在NICU住院的极低及超低出生体质量早产儿174例,采用区组随机化法分为研究组和对照组各87例。对照组采用常规出院指导;研究组采用以家庭为中心的出院指导计划。观察2组早产儿出院时、纠正胎龄2、4、6个月时的身高和体质量变化;观察入NICU时和出院时早产儿母亲护理知识、护理技能、焦虑评分(SAS)和抑郁评分(SDS),比较2组早产儿6个月内母乳喂养率、再住院率、患病率和病死率。结果 2组出生时和纠正胎龄40周体质量、身长和头围差异均无统计学意义(P0.05);纠正胎龄2个月、4个月、6个月研究组体质量、身长和头围均显著高于对照组(P0.05)。研究组母乳喂养率显著高于对照组(P0.05),患病率和再住院率显著低于对照组(P0.05),2组病死率差异无统计学意义(P0.05)。入NICU时,2组早产儿母亲的护理知识和护理技能差异均无统计学意义(P0.05),出院2个月时较入NICU时显著升高(P0.05),研究组提高更为显著(P0.05)。入NICU时,2组早产儿母亲的SAS和SDS评分差异均无统计学意义(P0.05),出院2个月时较入NICU时显著下降(P0.05),研究组下降更显著(P0.05)。结论对NICU早产儿实施以家庭为中心的出院指导,可促进患儿体格发育,降低患病率,改善家属不良情绪,具有重要的临床价值。     

Immediate control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization occurred from November 2001 in the neonatal intensive care unit (NICU) of our hospital. Since the establishment of our NICU in 1991, some MRSA has been detected in NICU patients. For MRSA infection preventive measures, utilization of the following items was implemented: mupirocin ointment, diluted povidone iodine, methylrosaniline chloride, and disposable rubber gloves. Patients in whom MRSA was detected received intranasal administration of the mupirocin ointment three times daily and were bathed in, or their entire body was wiped with diluted povidone iodine once daily for the first 3 days in each week. In addition, they received an intraoral application of methylrosaniline chloride daily. All therapy was done until MRSA strains were undetectable for 3 continuous weeks. Genotypes of 13 MRSA strains isolated from eight inpatients and one mother were analyzed by pulsed-field gel electrophoresis (PFGE). All PFGE patterns were identical, except for one, which had one distinct migrating fragment. These data suggested that this MRSA outbreak was caused by the same strain, which was derived from the mother of a low-birth-weight infant born on October 30, 2001. Gradually, the number of inpatients carrying MRSA decreased, until finally MRSA was no longer observed, in April 2002. Fortunately, we controlled the MRSA outbreak immediately, and none of the inpatients developed severe MRSA infection. We think that in our NICU, which is isolated from other hospital wards, it is important to prevent the entrance of MRSA-carrying mothers.     

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

Admission to the Neonatal Intensive Care Unit (NICU) is a psychologically and physically distressing event for infants. Preterm infants suffer from higher rates of depression and anxiety in childhood, adolescence, and adulthood, likely, at least in part, related to the experiences they have in the NICU. The parent-infant relationship is of paramount importance in determining the future trajectory of both the parent's and infant's mental health, and therefore it is critically important to both assess and support its development in the NICU. The challenges parents face in responding to their preterm, ill and fragile infants, and strategies to mitigate infant distress are outlined.     

Parental perspectives on technology use to enhance communication and closeness during the COVID-19 parental presence restrictions

ObjectiveTo explore parental perspectives on the use of technology in neonatal intensive care units (NICU), and its impact during COVID-19 parental presence restrictions.MethodsCo-designed online survey targeting parents of infants admitted to a Canadian NICU from March 1st, 2020 until March 5th, 2021.ResultsParents (n = 117) completed the survey from 38 NICUs. Large variation in policies regarding parental permission to use technology across sites was reported. Restrictive use of technology was reported as a source of parental stress. While families felt that technology helped them feel close to their infant when they could not be in the NICU, it did not replace being in-person.ConclusionLarge variation in policies were reported. Despite concerns about devices in NICUs, evidence on how to mitigate these concerns exists. Benefits of using technology to enhance parental experiences appear substantial. Future study is needed to inform recommendations on technology use in the NICU.     

Sleep Promotion for Preterm Infants in the NICU

Sleep is a crucial human physiologic need. Preterm infants in the NICU are exposed to noxious stimuli that often disrupt and shorten their sleep periods. Sleep disruption may have a negative effect on clinical outcomes, growth, and development and may also delay hospital discharge. Increasing evidence suggests that sleep quality is critical for brain development and synaptic plasticity and is associated with long-term neurodevelopmental outcomes. The purpose of this article is to discuss the importance of sleep in preterm infants, describe tools commonly used to assess infant sleep and identify different sleep–wake states, and identify interventions that promote sleep in preterm infants in the NICU. Nurses play a vital role in implementing appropriate interventions that promote preterm infants’ sleep.