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Application of the Adverse Childhood Experiences Framework to the NICU
Kathryn J Malin1, Dorothy Vittner, Umber Darilek
1College of Nursing, Marquette University, Milwaukee, Wisconsin (Dr Malin); Children's Wisconsin, Milwaukee (Dr Malin); Egan School of Nursing & Health Studies, Fairfield University, Fairfield, Connecticut (Dr Vittner); Department of Pediatrics (Dr Darilek) and School of Nursing (Drs McGlothen-Bell, Crawford, and McGrath), The University of Texas Health Science Center at San Antonio; University of Florida, Gainesville (Dr Koerner); Infant Feeding Care, Wellesley, Massachusetts (Dr Pados); School of Nursing, Old Dominion University, Norfolk, Virginia (Dr Cartagena); and Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan (Dr Vance).
Insights
The Adverse Childhood Experiences (ACEs) framework can guide neonatal intensive care unit (NICU) care, recognizing hospitalization as a potential ACE. Trauma-informed practices and supportive relationships mitigate risks for infant neurodevelopment and family well-being.
Area of Science:
- Neonatal care
- Developmental psychology
- Public health
Background:
- Neonatal intensive care unit (NICU) hospitalization causes significant stress and trauma for infants and families.
- Existing frameworks do not fully address the complex interplay of generational stress, pain, toxic stress, and parental separation in the NICU context.
- There is a critical need for structured approaches to guide clinical care and research on infant and family outcomes in the NICU.
Purpose of the Study:
- To apply the Adverse Childhood Experiences (ACEs) framework within the NICU setting.
- To provide a structure for guiding clinical practice and research on infant neurodevelopmental outcomes and parental attachment.
- To enhance understanding of risks and protective factors in the NICU environment.
Main Methods:
- Overview of the ACEs framework and its relevance to the NICU.
- Detailed discussion of risks at each level of the ACEs pyramid in the NICU context.
- Identification and discussion of supportive and protective factors to mitigate NICU-related ACEs.
Main Results:
- NICU hospitalization can be considered an Adverse Childhood Experience (ACE), increasing the risk of poorer health outcomes.
- Promoting safe, stable, and nurturing relationships is crucial.
- Trauma-informed care and individualized developmental care can counteract the negative effects of NICU stress.
Conclusions:
- Nurses play a vital role in balancing NICU stimulation through practices like skin-to-skin care and parental involvement.
- The ACEs framework offers a valuable lens for future research on cumulative risk and well-being in NICU populations.
- Implementing trauma-informed care is essential for improving infant and family outcomes.
Background:
Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families.
Purpose:
Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment.
Methods:
An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed.
Results:
NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU.
Implications For Practice And Research:
Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.
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