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Published on: January 7, 2020
Concern for mortality in the neonatal intensive care unit (NICU): parent and physician perspectives
Jaclyn Boulais1,2, Teresa Vente3, Mary Daley3
1Division of Newborn Medicine, The Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA. jboulais@tuftsmedicalcenter.org.
Insights
Parental concern for mortality (PCM) in the Neonatal Intensive Care Unit (NICU) affects nearly half of parents and is linked to infant care duration, not gestational age. Many parents desire more discussions about PCM.
Area of Science:
- Neonatal Medicine
- Pediatric Psychology
- Healthcare Communication
Background:
- Parental Concern for Mortality (PCM) is a significant factor for infants in the Neonatal Intensive Care Unit (NICU).
- Understanding predictors and physician perspectives on PCM is crucial for improving family-centered care.
Purpose of the Study:
- To determine the incidence and predictors of PCM in NICU parents.
- To explore physicians' views on PCM and current practices for addressing it.
Main Methods:
- Surveys distributed to physicians and NICU parents post-discharge.
- Statistical analysis including chi-squared analysis and linear regression.
Main Results:
- 48% of parents reported PCM; it was associated with infant length of stay and physician discussions, but not gestational age.
- Physicians believed PCM correlated with lower gestational age and had fewer discussions with parents of older infants.
- 53% of parents reported never discussing PCM with physicians.
Conclusions:
- Parental reports indicate PCM is not solely linked to gestational age, contrary to physician belief.
- Parents of full-term infants may experience significant PCM and desire more communication than currently provided.
Objective:
The objectives of this study are as follows: (1) to determine the incidence of parental concern for mortality (PCM) and any potential predictors for it among parents of infants admitted to the Neonatal Intensive Care Unit (NICU), and (2) to explore physicians' perspectives with respect to PCM in the NICU and to examine current practices of addressing it.
Study Design:
Separate questionnaires were distributed to members of the AAP Section on Perinatal-Neonatal Medicine District I and to NICU parents post discharge, to gather perspectives from each group. A χ2-analysis and linear regression were performed.
Results:
Response rate was 29% for the physician survey and 63% for the parent survey. Physician respondents believed that PCM increased with decreasing gestational age (GA) and reported having fewer discussions with parents of older infants about PCM. Parental report of PCM incidence was 48% overall. PCM was not associated with GA. PCM was associated with infant length of stay and occurrence of at least one discussion about PCM with physicians. Fifty-three percent of parents reported never having a discussion regarding PCM.
Conclusion:
Although physicians believe that PCM increases with decreasing GA, parental report suggests that PCM is not associated with GA. Parents of full-term infants in particular may experience more PCM and desire for discussion than is currently recognized.
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