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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Parent-infant interaction in the NICU: Challenges in measurement
M Richter1, K Fehringer2, J Smith3
1University of Southern California, Chan Division of Occupational Science and Occupational Therapy, 1540 Alcazar St, Los Angeles, CA 90089, United States of America.
Insights
The Nursing Child Assessment Feeding Scale (NCAFS) may not effectively measure parent-infant interaction in the NICU for preterm infants. Enhanced parent education was unexpectedly linked to lower interaction scores.
Area of Science:
- Neonatal care
- Parent-infant interaction research
- Developmental psychology
Background:
- Parent-infant interaction is not well understood in Neonatal Intensive Care Unit (NICU) settings, especially for high-risk dyads.
- Existing parent-infant interaction measures are not specifically designed for preterm infants in the NICU or tailored to educational interventions.
Purpose of the Study:
- To investigate the relationships between parent-infant interaction scores (using the Nursing Child Assessment Feeding Scale - NCAFS) and various factors in the NICU.
- To assess the impact of enhanced parental education on parent-infant interaction tailored to infant cues.
Main Methods:
- Video recorded oral feedings of 26 preterm infants (born ≤32 weeks) by their parents in the NICU.
- Scoring of parent-infant interaction using the NCAFS by a certified evaluator.
- Analysis of relationships between NCAFS scores and socio-demographic factors, parent mental health, and enhanced parental education.
Main Results:
- 65% of parent-infant dyads scored below the 10th percentile on the NCAFS.
- No significant relationships were found between NCAFS scores and socio-demographic factors or parental mental health.
- Dyads receiving enhanced parent education had significantly lower NCAFS scores compared to those receiving usual care (p=0.01).
Conclusions:
- The study questions the utility and appropriateness of the NCAFS for assessing parent-infant interaction in preterm infants within the NICU.
- Further research is needed to determine if the NCAFS accurately captures interaction dynamics in this high-risk population.
- The findings suggest a need for NICU-specific measures that account for educational interventions and infant cues.
Background:
Parent-infant interaction is poorly understood among high-risk dyads in NICU settings. No parent-infant interaction measures are specifically designed for preterm infants within the NICU nor account for the education NICU parents receive to tailor their interactions based on the infant's cues.
Aim:
To improve our understanding of a measure of parent-infant interaction in the NICU, we investigated relationships between parent-infant interaction scores on the Nursing Child Assessment Feeding Scale (NCAFS) and 1) socio-demographic and medical factors, 2) parent mental health and confidence, and 3) enhanced parental education (delivered as part of the Supporting and Enhancing NICU Sensory Experiences program) on tailoring interactions based on the infant's cues.
Method:
Twenty-six preterm infants (born ≤32 weeks) had a video recorded oral feeding conducted by a parent in the NICU when the infant was 34-48 weeks postmenstrual age. A certified evaluator scored parent-infant interaction from the videos using the NCAFS.
Results:
Seventeen (65 %) parent-infant dyads scored below the 10th percentile on the total NCAFS score. Despite it being well-understood that parent-infant interaction is related to sociodemographic factors and parental mental health, there were no relationships between these factors and NCAFS scores in this study. Dyads who received enhanced parent education (n = 15) had lower NCAFS scores than dyads receiving usual care (n = 11) (p = 0.01).
Conclusion:
It remains unclear if the standard measure of parent-infant interaction, NCAFS, captured positive and negative interactions in context of assessment of a high-risk dyad within the NICU setting. The utility of the NCAFS with preterm infants in the NICU was not supported by this study.
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