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Published on: January 7, 2020
Parent participation in the neonatal intensive care unit: Predictors and relationships to neurobehavior and
Roberta Pineda1, Joy Bender2, Bailey Hall3
1Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
Insights
Parental presence and holding in the neonatal intensive care unit (NICU) are influenced by social and medical factors. Increased parent holding, including skin-to-skin care, is linked to improved infant neurobehavior and long-term development.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Family-centered care
Background:
- Parental involvement in the neonatal intensive care unit (NICU) is crucial for infant well-being.
- Factors influencing parent presence and physical contact (holding, skin-to-skin care) require further definition.
- The impact of early parent participation on neurodevelopmental trajectories of preterm infants is not fully understood.
Purpose of the Study:
- To identify predictors of parent presence and various forms of physical contact in the NICU.
- To examine the association between parent participation and early neurobehavior in preterm infants.
- To investigate the relationship between parent engagement and developmental outcomes at 4–5 years of age.
Main Methods:
- Prospective enrollment of 81 preterm infants (born ≤32 weeks gestation) in a level III-IV NICU.
- Systematic tracking of maternal and paternal presence and holding (in arms, skin-to-skin) throughout NICU stay.
- Standardized assessments of neurobehavior at term equivalent age and development at 4–5 years.
Main Results:
- Parent presence was associated with maternal Caucasian ethnicity, marriage, older age, employment, fewer children, family support, and breastfeeding.
- Parent holding was linked to fewer medical interventions, paternal employment, and less family support.
- Increased parent holding correlated with better reflex development at term age.
- Skin-to-skin care predicted better infant reflexes, less asymmetry at term, and improved gross motor skills at 4–5 years.
Conclusions:
- Social and medical factors significantly influence parent engagement in the NICU.
- Parental holding and skin-to-skin care are associated with positive short-term and long-term developmental outcomes for preterm infants.
- Engaging families in NICU care is vital for optimizing infant development.
Objective:
To 1) define predictors of parent presence, any holding, holding in arms, and skin-to-skin care in the NICU and 2) investigate the relationships between parent participation and a) early neurobehavior and b) developmental outcomes at age 4 to 5years among preterm infants.
Methods:
Eighty-one preterm infants born ≤32weeks estimated gestational age were prospectively enrolled within one week of life in a level III-IV NICU. Parent (maternal and paternal) presence and holding (including holding in arms and skin-to-skin care) were tracked throughout NICU hospitalization. Neurobehavior at term equivalent age and development at 4 to 5years were determined using standardized assessments.
Results:
The median number of days per week parents were documented to be present over NICU hospitalization was 4.0 (IQR=2.4-5.8) days; days held per week 2.8 (IQR=1.4-4.3) days [holding in arms days per week was 2.2 (IQR=1.2-3.2) days and parent skin-to-skin care days per week was 0.2 (IQR=0.0-0.7) days]. More parent presence was observed among mothers who were Caucasian, married, older, or employed and among those who had fewer children, familial support and provided breast milk (p<0.05). More holding was observed in infants with fewer medical interventions (p<0.05) and among those who were Caucasian, had a father who was employed, had fewer children and family support (p<0.05). More parent holding in the NICU was related to better reflex development at term age (p=0.02). More parent skin-to-skin care was related to better infant reflexes (p=0.03) and less asymmetry (p=0.04) at term and better gross motor development (p=0.02) at 4-5years.
Discussion:
Social and medical factors appear to impact parent presence, holding, and skin-to-skin care in the NICU. Parent holding is related to better developmental outcomes, which highlights the importance of engaging families in the NICU.
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