Closeness and separation in neonatal intensive care

Renée Flacking, Liisa Lehtonen, Gill Thomson, Anna Axelin, Sari Ahlqvist, Victoria Hall Moran, Uwe Ewald, Fiona Dykes, Separation and Closeness Experiences in the Neonatal Environment (SCENE) group, Hedvig Strand, Erik Normann, Lars Wallin, Jaakko Matomäki, Zack Boukydis, Renée Flacking, Liisa Lehtonen, Gill Thomson, Anna Axelin, Sari Ahlqvist, Victoria Hall Moran, Uwe Ewald, Fiona Dykes, Separation and Closeness Experiences in the Neonatal Environment (SCENE) group, Hedvig Strand, Erik Normann, Lars Wallin, Jaakko Matomäki, Zack Boukydis

Abstract

In this paper, we highlight the need for acknowledging the importance and impact of both physical and emotional closeness between the preterm infant and parent in the neonatal intensive care unit. Physical closeness refers to being spatially close and emotional closeness to parental feelings of being emotionally connected to the infant (experiencing feelings of love, warmth and affection). Through consideration of the literature in this area, we outline some of the reasons why physical closeness and emotional closeness are crucial to the physical, emotional and social well-being of both the infant and the parent. These include positive effects on infant brain development, parent psychological well-being and on the parent-infant relationship. The influence of the neonatal unit environment and culture on physical and emotional closeness is also discussed.

Conclusions: Culturally sensitive care practices, procedures and the physical environment need to be considered to facilitate parent-infant closeness, such as through early and prolonged skin-to-skin contact, family-centred care, increased visiting hours, family rooms and optimization of the space on the units. Further research is required to explore factors that facilitate both physical and emotional closeness to ensure that parent-infant closeness is a priority within neonatal care.

© 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.

References

    1. Meaney MJ, Szyf M. Maternal care as a model for experience-dependent chromatin plasticity? Trends Neurosci. 2005;28:456–63.
    1. Champagne FA. Epigenetic influence of social experiences across the lifespan. Dev Psychobiol. 2010;52:299–311.
    1. Welberg LA, Seckl JR. Prenatal stress, glucocorticoids and the programming of the brain. J Neuroendocrinol. 2001;13:113–28.
    1. Feng X, Wang L, Yang S, Qin D, Wang J, Li C, et al. Maternal separation produces lasting changes in cortisol and behavior in rhesus monkeys. Proc Natl Acad Sci U S A. 2011;108:14312–7.
    1. Braun K. The prefrontal-limbic system: development, neuroanatomy, function, and implications for socioemotional development. Clin Perinatol. 2011;38:685–702.
    1. Sullivan R, Perry R, Sloan A, Kleinhaus K, Burtchen N. Infant bonding and attachment to the caregiver: insights from basic and clinical science. Clin Perinatol. 2011;38:643–55.
    1. Hofer M. Psychobiological roots of early attachment. Curr Dir Psychol Sci. 2006;15:84–8.
    1. Bugental DB, Beaulieu D, Schwartz A. Hormonal sensitivity of preterm versus full-term infants to the effects of maternal depression. Infant Behav Dev. 2008;31:51–61.
    1. Morelius E, Nelson N, Gustafsson PA. Salivary cortisol response in mother-infant dyads at high psychosocial risk. Child Care Health Dev. 2007;33:128–36.
    1. Morelius E, Theodorsson E, Nelson N. Salivary cortisol and mood and pain profiles during skin-to-skin care for an unselected group of mothers and infants in neonatal intensive care. Pediatrics. 2005;116:1105–13.
    1. Als H, Duffy FH, McAnulty GB, Rivkin MJ, Vajapeyam S, Mulkern RV, et al. Early experience alters brain function and structure. Pediatrics. 2004;113:846–57.
    1. Milgrom J, Newnham C, Anderson PJ, Doyle LW, Gemmill AW, Lee K, et al. Early sensitivity training for parents of preterm infants: impact on the developing brain. Pediatr Res. 2010;67:330–5.
    1. Scher MS, Ludington-Hoe S, Kaffashi F, Johnson MW, Holditch-Davis D, Loparo KA. Neurophysiologic assessment of brain maturation after an 8-week trial of skin-to-skin contact on preterm infants. Clin Neurophysiol. 2009;120:1812–8.
    1. Feldman R, Weller A, Sirota L, Eidelman AI. Skin-to-Skin contact (Kangaroo care) promotes self-regulation in premature infants: sleep-wake cyclicity, arousal modulation, and sustained exploration. Dev Psychol. 2002;38:194–207.
    1. Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev. 2011:CD006275.
    1. Field T, Diego M, Hernandez-Reif M. Preterm infant massage therapy research: a review. Infant Behav Dev. 2010;33:115–24.
    1. Caskey M, Stephens B, Tucker R, Vohr B. Importance of parent talk on the development of preterm infant vocalizations. Pediatrics. 2011;128:910–6.
    1. Treyvaud K, Anderson VA, Howard K, Bear M, Hunt RW, Doyle LW, et al. Parenting behavior is associated with the early neurobehavioral development of very preterm children. Pediatrics. 2009;123:555–61.
    1. Feldman R, Eidelman A. Skin-to-skin contact (Kangaroo care) accelerates autonomic and neurobehavioural maturation in preterm infants. Dev Med Child Neurol. 2003;45:274–81.
    1. Montirosso R, Del Prete A, Bellù R, Tronick E, Borgatti R the Neonatal Adequate Care for Quality of Life (NEO-ACQUA) Study Group. Level of NICU quality of developmental care and neurobehavioral performance in very preterm infants. Pediatrics. 2012;129:e1129–37.
    1. Achenbach TM, Howell CT, Aoki MF, Rauh VA. Nine-year outcome of the Vermont intervention program for low birth weight infants. Pediatrics. 1993;91:45–55.
    1. Nordhov SM, Ronning JA, Dahl LB, Ulvund SE, Tunby J, Kaaresen PI. Early intervention improves cognitive outcomes for preterm infants: randomized controlled trial. Pediatrics. 2010;126:e1088–94.
    1. Brandon DH, Tully KP, Silva SG, Malcolm WF, Murtha AP, Turner BS, et al. Emotional responses of mothers of late-preterm and term infants. J Obstet Gynecol Neonatal Nurs. 2011;40:719–31.
    1. Jackson K, Ternestedt BM, Schollin J. From alienation to familiarity: experiences of mothers and fathers of preterm infants. J Adv Nurs. 2003;43:120–9.
    1. Franck LS, Cox S, Allen A, Winter I. Measuring neonatal intensive care unit-related parental stress. J Adv Nurs. 2005;49:608–15.
    1. Miles MS, Holditch-Davis D, Schwartz T, Scher M. Depressive symptoms in mothers of prematurely born infants. J Dev Behav Pediatr. 2007;28:36–44.
    1. Arockiasamy V, Holsti L, Albersheim S. Fathers’ experiences in the neonatal intensive care unit: a search for control. Pediatrics. 2008;121:e215–22.
    1. Flacking R, Ewald U, Nyqvist KH, Starrin B. Trustful bonds: a key to “becoming a mother” and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit. Soc Sci Med. 2006;62:70–80.
    1. Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, et al. Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics. 2006;118:e1414–27.
    1. de Alencar AE, Arraes LC, de Albuquerque EC, Alves JG. Effect of kangaroo mother care on postpartum depression. J Trop Pediatr. 2009;55:36–8.
    1. Huhtala M, Korja R, Lehtonen L, Haataja L, Lapinleimu H, Rautava P. Parental psychological well-being and behavioral outcome of very low birth weight infants at 3 years. Pediatrics. 2012;129:e937–44.
    1. Habib C, Lancaster S. Changes in identity and paternal-foetal attachment across a first pregnancy. J Reprod Infant Psychol. 2010;28:128–42.
    1. Mercer J. Understanding attachment: parenting, child care and emotional development. Westport, CT: Praeger; 2006.
    1. Lagercrantz H, Changeux JP. The emergence of human consciousness: from fetal to neonatal life. Pediatr Res. 2009;65:255–60.
    1. Parsons CE, Young KS, Murray L, Stein A, Kringelbach ML. The functional neuroanatomy of the evolving parent-infant relationship. Prog Neurobiol. 2010;91:220–41.
    1. Korja R, Latva R, Lehtonen L. The effects of preterm birth on mother-infant interaction and attachment during the infant’s first two years. Acta Obstet Gynecol Scand. 2012;91:164–73.
    1. Feldman R, Weller A, Leckman JF, Kuint J, Eidelman AI. The nature of the mother’s tie to her infant: maternal bonding under conditions of proximity, separation, and potential loss. J Child Psychol Psychiatry. 1999;40:929–39.
    1. Latva R, Korja R, Salmelin R, Lehtonen L, Tamminen T. How is maternal recollection of the birth experience related to the behavioral and emotional outcome of preterm infants? Early Hum Dev. 2008;84:587–94.
    1. Sullivan JR. Development of father-infant attachment in fathers of preterm infants. Neonatal Netw. 1999;18:33–9.
    1. Goulet C, Bell L, St-Cyr D, Paul D, Lang A. A concept analysis of parent-infant attachment. J Adv Nurs. 1998;28:1071–81.
    1. Forcada-Guex M, Pierrehumbert B, Borghini A, Moessinger A, Muller-Nix C. Early dyadic patterns of mother-infant interactions and outcomes of prematurity at 18 months. Pediatrics. 2006;118:e107–14.
    1. Muller-Nix C, Forcada-Guex M, Pierrehumbert B, Jaunin L, Borghini A, Ansermet F. Prematurity, maternal stress and mother-child interactions. Early Hum Dev. 2004;79:145–58.
    1. Garel M, Dardennes M, Blondel B. Mothers’ psychological distress 1 year after very preterm childbirth. Results of the EPIPAGE qualitative study. Child Care Health Dev. 2007;33:137–43.
    1. Sweet L. Breastfeeding a preterm infant and the objectification of breastmilk. Breastfeed Rev. 2006;14:5–13.
    1. Uvnas-Moberg K, Eriksson M. Breastfeeding: physiological, endocrine and behavioural adaptations caused by oxytocin and local neurogenic activity in the nipple and mammary gland. Acta Paediatr. 1996;85:525–30.
    1. Nyqvist KH, Anderson GC, Bergman N, Cattaneo A, Charpak N, Davanzo R, et al. State of the art and recommendations. Kangaroo mother care: application in a high-tech environment. Acta Paediatr. 2010;99:812–9.
    1. White RD. The newborn intensive care unit environment of care: how we got here, where we’re headed, and why. Semin Perinatol. 2011;35:2–7.
    1. Teltsch DY, Hanley J, Loo V, Goldberg P, Gursahaney A, Buckeridge DL. Infection acquisition following intensive care unit room privatization. Arch Intern Med. 2011;171:32–8.
    1. Domanico R, Davis DK, Coleman F, Davis BO. Documenting the NICU design dilemma: comparative patient progress in open-ward and single family room units. J Perinatol. 2011;31:281–8.
    1. Ortenstrand A, Westrup B, Brostrom EB, Sarman I, Akerström S, Brune T, et al. The Stockholm Neonatal Family Centered Care Study: effects on length of stay and infant morbidity. Pediatrics. 2010;125:e278–85.
    1. Carter BS, Carter A, Bennett S. Families’ views upon experiencing change in the neonatal intensive care unit environment: from the ‘baby barn’ to the private room. J Perinatol. 2008;28:827–9.
    1. Greisen G, Mirante N, Haumont D, Pierrat V, Pallás-Alonso CR, Warren I, et al. Parents, siblings and grandparents in the Neonatal Intensive Care Unit. A survey of policies in eight European countries. Acta Paediatr. 2009;98:1744–50.
    1. Davis L, Mohay H, Edwards H. Mothers’ involvement in caring for their premature infants: an historical overview. J Adv Nurs. 2003;42:578–86.
    1. Franck LS, Spencer C. Parent visiting and participation in infant caregiving activities in a neonatal unit. Birth. 2003;30:31–5.
    1. Latva R, Lehtonen L, Salmelin RK, Tamminen T. Visits by the family to the neonatal intensive care unit. Acta Paediatr. 2007;96:215–20.
    1. Yeo C, Ho SK, Khong K, Lau Y. Virtual visitation in the neonatal intensive care: experience with the use of internet and telemedicine in a tertiary neonatal unit. Perm J. 2011;15:32–6.
    1. Peters KL. Infant handling in the NICU: does developmental care make a difference? An evaluative review of the literature. J Perinat Neonatal Nurs. 1999;13:83–109.
    1. Domanico R, Davis DK, Coleman F, Davis BO., Jr Documenting the NICU design dilemma: parent and staff perceptions of open ward versus single family room units. J Perinatol. 2010;30:343–51.
    1. Franck LS, Bernal H, Gale G. Infant holding policies and practices in neonatal units. Neonatal Netw. 2002;21:13–20.
    1. Bonet M, Blondel B, Agostino R, Combier E, Maier RF, Cuttini M, et al. Variations in breastfeeding rates for very preterm infants between regions and neonatal units in Europe: results from the MOSAIC cohort. Arch Dis Child Fetal Neonatal Ed. 2011;96:450–2.

Source: PubMed

3
Abonnieren