Giving parents support: a randomized trial of peer support for parents after NICU discharge

Karen Fratantoni, Lamia Soghier, Katherine Kritikos, Juliana Jacangelo, Nicole Herrera, Lisa Tuchman, Penny Glass, Randi Streisand, Marni Jacobs, Karen Fratantoni, Lamia Soghier, Katherine Kritikos, Juliana Jacangelo, Nicole Herrera, Lisa Tuchman, Penny Glass, Randi Streisand, Marni Jacobs

Abstract

Background: Peer support during inpatient hospitalization has been recommended for NICU parents and can improve maternal mental health. Less is known about the impact of peer support after NICU discharge on parental mental health and infant healthcare utilization.

Methods: Three hundred families of infants approaching discharge from a Level IV NICU were randomized to receive a care notebook (control) or care notebook plus peer support for 12 months (intervention). Participants reported on measures of stress, depression, anxiety, self-efficacy, and infant healthcare utilization. Analysis compared outcomes between control and treatment groups.

Results: Parental depression, anxiety, stress, and self-efficacy improved significantly for all participants, yet there were no differences between control and intervention groups. Infant ED visits, hospitalizations, immunization status, and developmental status at 12 months did not differ between groups.

Conclusions: Peer support after NICU discharge did not improve self-reported parental mental health measures or infant healthcare utilization.

Clinical trial registration: NCT02643472.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1. CONSORT Diagram.
Fig. 1. CONSORT Diagram.
Diagram of participant eligibility, assessment, enrollment and randomization [24].
Fig. 2. Trajectory of Mental Health Outcomes…
Fig. 2. Trajectory of Mental Health Outcomes Between Groups.
Parental self-efficacy, perceived stress, parental stress, anxiety and depression among those in intervention and control over the 12 months after NICU discharge.

References

    1. Roman L, Lindsay J, Boger R, Dewys M, Beaumont E, Jones A, et al. Parent‐to‐parent support initiated in the neonatal intensive care unit. Res Nurs Health. 1995;18:385–94. doi: 10.1002/nur.4770180504.
    1. Preyde M, Ardal F. Effectiveness of a parent “buddy” program for mothers of very preterm infants in a neonatal intensive care unit. CMAJ. 2003;168:969–73.
    1. Ireys H, Chernoff R, DeVet K, Kim Y. Maternal outcomes of a randomized controlled trial of a community-based support program for families of children with chronic illnesses. Arch Pediatrics Adolesc Med. 2001;155:771–7. doi: 10.1001/archpedi.155.7.771.
    1. Hall S, Ryan D, Beatty J, Grubbs L. Recommendations for peer-to-peer support for NICU parents. J Perinatol. 2015;35:S9–13. doi: 10.1038/jp.2015.143.
    1. Committee on Hospital Care and Institute for Patient and Family Centered Care. Patient- and family-centered care and the pediatrician’s role. Pediatrics. 2012;129:394–404. doi: 10.1542/peds.2011-3084.
    1. Feeley N, Zelkowitz P, Cormier C, Charbonneau L, Lacroix A, Papageorgiou A. Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit. Appl Nurs Res. 2011;24:114–7. doi: 10.1016/j.apnr.2009.04.004.
    1. Lefkowitz D, Baxt C, Evans J. Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the neonatal intensive care unit (NICU) J Clin Psychol Med Settings. 2010;17:230–7. doi: 10.1007/s10880-010-9202-7.
    1. Shaw R, Bernard R, DeBlois T, Ikuta L, Ginzburg K, Koopman C. The relationship between acute stress disorder and posttraumatic stress disorder in the neonatal intensive care unit. Psychosomatics. 2009;50:131–7. doi: 10.1176/appi.psy.50.2.131.
    1. Paul I, Downs D, Schaefer E, Beiler J, Weisman C. Postpartum anxiety and maternal-infant health outcomes. PEDIATRICS. 2013;131:e1218–24. doi: 10.1542/peds.2012-2147.
    1. Minkovitz C, Strobino D, Scharfstein D, Hou W, Miller T, Mistry K, et al. Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life. Pediatrics. 2005;115:306–14. doi: 10.1542/peds.2004-0341.
    1. Holland M, Yoo B, Kitzman H, Chaudron L, Szilagyi P, Temkin-Greener H. Self-efficacy as a mediator between maternal depression and child hospitalizations in low-income urban families. Matern Child Health J. 2011;15:1011–9. doi: 10.1007/s10995-010-0662-z.
    1. Hynan M, Mounts K, Vanderbilt D. Screening parents of high-risk infants for emotional distress: rationale and recommendations. J Perinatol. 2013;33:748–53. doi: 10.1038/jp.2013.72.
    1. Pace C, Spittle A, Molesworth C, Lee K, Northam E, Cheong J, et al. Evolution of depression and anxiety symptoms in parents of very preterm infants during the newborn period. JAMA Pediatr. 2016;170:863–70. doi: 10.1001/jamapediatrics.2016.0810.
    1. Willis V. Parenting preemies: a unique program for family support and education after NICU discharge. Adv Neonatal Care. 2008;8:221–30. doi: 10.1097/01.ANC.0000333710.83517.19.
    1. Purdy I, Melwak M. Who is at risk? High-risk infant follow-up. Newborn Infant Nurs Rev. 2012;12:221–6. doi: 10.1053/j.nainr.2012.09.011.
    1. Smith V, Hwang S, Dukhovny D, Young S, Pursley D. Neonatal intensive care unit discharge preparation, family readiness and infant outcomes: connecting the dots. J Perinatol. 2013;33:415–21. doi: 10.1038/jp.2013.23.
    1. Hynan M, Steinberg Z, Baker L, et al. Recommendations for mental health professionals in the NICU. J Perinatol. 2015;35:S14–8. doi: 10.1038/jp.2015.144.
    1. Penny K, Friedman S, Halstead G. Psychiatric support for mothers in the Neonatal Intensive Care Unit. J Perinatol. 2015;35:451–7. doi: 10.1038/jp.2014.221.
    1. Hatters Friedman S, Kessler A, Nagle Yang S, Parsons S, Friedman H, Martin R. Delivering perinatal psychiatric services in the neonatal intensive care unit. Acta Paediat. 2013;102:392–7. doi: 10.1111/apa.12323.
    1. Purdy I, Craig J, Zeanah P. NICU discharge planning and beyond: recommendations for parent psychosocial support. J Perinatol. 2015;35:S24–8. doi: 10.1038/jp.2015.146.
    1. Silow-Carroll S. Rhode Island’s Pediatric Practice Enhancement Project: Parents Helping Parents and Practitioners [Internet]. Commonwealth Fund; 2009. Available from: . Accessed 3/3/22.
    1. Dennis C. Peer support within a health care context: a concept analysis. Int J Nurs Stud. 2003;40:321–32. doi: 10.1016/S0020-7489(02)00092-5.
    1. Carty C, Soghier L, Kritikos K, Tuchman L, Jiggetts M, Glass P, et al. The giving parents support study: a randomized clinical trial of a parent navigator intervention to improve outcomes after neonatal intensive care unit discharge. Contemp Clin Trials. 2018;70. 10.1016/j.cct.2018.05.004.
    1. Fratantoni K, Kritikos K, Jacangelo J, Herrera N, Jacobs M. Testing a peer-support program for parents of infants going home from the NICU. 2020. 10.25302/06.2020.IHS.140311567.
    1. March of Dimes. Levels of Medical Care for Your Newborn. Published 2015. Accessed 30 Dec 2021. .
    1. Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J. Research Electronic Data Capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81. doi: 10.1016/j.jbi.2008.08.010.
    1. Aftyka A, Rybojad B, Rozalska-Walaszek I, Rzoñca P, Humeniuk E. Post-traumatic stress disorder in parents of children hospitalized in the neonatal intensive care unit (NICU): medical and demographic risk factors. Psychiatr Danubina. 2014;26:347–52.
    1. Lee S, Hsu H. Stress and health-related well-being among mothers with a low birth weight infant: the role of sleep. Soc Sci Med. 2012;74:958–65. doi: 10.1016/j.socscimed.2011.12.030.
    1. Howland L, Pickler R, McCain N, Glaser D, Lewis M. Exploring Biobehaviooal Outcomes in Mothers of Preterm Infants. MCN: Am J Matern/Child Nurs. 2011;36:91–7. doi: 10.1097/NMC.0b013e318205587e.
    1. Silverstein M, Feinberg E, Cabral H, Linhart Y, Sandler J, Hegel M, et al. Potential impact of trauma on the ability to prevent depression among low-income mothers. Depress Anxiety. 2011;28:478–84. doi: 10.1002/da.20817.
    1. Northrup T, Green C, Evans P, Stotts A. Characteristics associated with intervention and follow-up attendance in a secondhand smoke exposure study for families of NICU infants. J Matern Fetal Neonatal Med. 2015;28:1208–13. doi: 10.3109/14767058.2014.947950.
    1. Schaffer L, Jallo N, Howland L, James K, Glaser D, Arnell K. Guided imagery: an innovative approach to improving maternal sleep quality. J Perinat Neonatal Nurs. 2013;27:151–9. doi: 10.1097/JPN.0b013e3182870426.
    1. Harris R, Gibbs D, Mangin-Heimos K, Pineda R. Maternal mental health during the neonatal period: Relationships to the occupation of parenting. Early Hum Dev. 2018;120:31–9. doi: 10.1016/j.earlhumdev.2018.03.009.
    1. Cyr-Alves H, Macken L, Hyrkas K. Stress and symptoms of depression in fathers of infants admitted to the NICU. JOGNN. 2018;47:146–57. doi: 10.1016/j.jogn.2017.12.006.
    1. Barnes C, Adamson-Macedo E. Perceived maternal parenting self-efficacy (PMP S-E) tool: development and validation with mothers of hospitalized preterm neonates. J Adv Nurs. 2007;60:550–60. doi: 10.1111/j.1365-2648.2007.04445.x.
    1. Ingram J, Powell J, Blair P, Pontin D, Redshaw M, Manns S, et al. Does family-centered neonatal discharge planning reduce healthcare usage? A before and after study in South West England. BMJ Open. 2016;6. 10.1136/bmjopen-2015-010752.
    1. Hsiao R. Application of Perceived Maternal Parenting Self-Efficacy (PMP S-E) Questionnaire in a Mid-West Community Medical Center NICU in the United States. Neonatal Pediatr Med. 2016;2:1–6. doi: 10.4172/2572-4983.1000106.
    1. Jones R, Jones L, Feary A. The effects of single-family rooms on parenting behavior and maternal psychological factors. JOGNN. 2016;45:359–70. doi: 10.1016/j.jogn.2015.12.015.
    1. Mackley A, Locke R, Spear M, Joseph R. Forgotten parent: NICU paternal emotional response. Adv Neonatal Care. 2010;10:200–3. doi: 10.1097/ANC0b013e3181e946f0.
    1. Holditch-Davis D, White-Traut R, Levy J, O’Shea T, Geraldo V, David R. Maternally administered interventions for preterm infants in the NICU: Effects on maternal psychological distress and mother-infant relationship. Infant Behav Dev. 2014;37:695–710. doi: 10.1016/j.infbeh.2014.08.005.
    1. Greene M, Rossman B, Patra K, Kratovil A, Janes J, Meier P. Depression, anxiety, and perinatal-specific posttraumatic distress in mothers of very low birth weight infants in the neonatal intensive care unit. J Dev Behav Pediatr. 2015;36:362–70. doi: 10.1097/DBP.0000000000000174.
    1. Stotts A, Evans P, Green C, Northrup T, Dodrill C, Fox J, et al. Secondhand smoke risk in infants discharged from an NICU: potential for significant health disparities? Nicotine Tob Res. 2011;13:1015–22. doi: 10.1093/ntr/ntr116.
    1. Welch M, Halperin M, Austin J, Stark R, Hofer M, Hane A, et al. Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with Family Nurture Intervention in the NICU. Arch Womens Ment Health. 2016;19:51–61. doi: 10.1007/s00737-015-0502-7.
    1. Padovani F, Carvalho A, Duarte G, Martinez F, Linhares M. Anxiety, dysphoria, and depression symptoms in mothers of preterm infants. Psychological Rep. 2009;104:667–79. doi: 10.2466/pr0.104.2.667-679.
    1. Pineda R, Castellano A, Rogers C, Neil J, Inder T. Factors associated with developmental concern and intent to access therapy following discharge from the NICU. Pediatr Phys Ther. 2013;25:62–9. doi: 10.1097/PEP.0b013e31827a822c.
    1. Greene M, Rossman B, Patra K, Kratovil A, Khan S, Meier P. Maternal psychological distress and visitation to the neonatal intensive care unit. Acta Paediatr. 2015;104:e306–13. doi: 10.1111/apa.12975.
    1. Yurdakul Z, Akman I, Kuscu M, Karabekiroglu A, Yaylali G, Demir F, et al. Maternal psychological problems associated with neonatal intensive care admission. Int J Pediatr. 2009;2009:591359. doi: 10.1155/2009/591359.
    1. Shewchuk R, Richards J, Elliott T. Dynamic processes in health outcomes among caregivers of patients with spinal cord injuries. Health Psychol. 1998;17:125–9. doi: 10.1037/0278-6133.17.2.125.
    1. Carter JD, Roger T, Mulder B. Parental stress in the NICU: The influence of personality, psychological, pregnancy and family factors. Personal Ment Health. 2009;95:86–95. doi: 10.1002/pmh.
    1. Pinelli J. Effects of family coping and resources on family adjustment and parental stress in the acute phase of the NICU experience. Neonatal Netw. 2000;19:27–37. doi: 10.1891/0730-0832.19.6.27.
    1. Sisk P. Lactation counseling for mothers of very low birth weight infants: effect on maternal anxiety and infant intake of human milk. Pediatrics. 2006;117:e67–75. doi: 10.1542/peds.2005-0267.
    1. Holditch-Davis D, Miles M, Weaver M, Black B, Beeber L, Thoyre S, et al. Patterns of distress in African-American mothers of preterm infants. J Dev Behav Pediatr. 2009;30:193–205. doi: 10.1097/DBP.0b013e3181a7ee53.
    1. Franck L. Parental concern and distress about infant pain. Arch Dis Child Fetal Neonatal Ed. 2004;89:71F–75. doi: 10.1136/fn.89.1.F71.
    1. Rogers C, Kidokoro H, Wallendorf M, Inder T. Identifying mothers of very preterm infants at-risk for postpartum depression and anxiety before discharge. J Perinatol. 2013;33:171–6. doi: 10.1038/jp.2012.75.
    1. Hib ACIP Vaccine Recommendations (Haemophilus Influenzae Type B) Advisory Committee on Immunization Practices (ACIP). . Accessed 3/3/2022.
    1. Bayley N. Bayley Scales of infant and toddler development—third edition. San Antonio, TX: Harcourt Assessment. J Psychoeducational Assess. 2006;25:180–90. doi: 10.1177/0734282906297199.
    1. Andresen E, Malmgren J, Carter W, Patrick D. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale) Am J Prev Med. 1994;10:77–84. doi: 10.4236/health.2013.53A078.
    1. Spielberger C, Gorsuch R, Lushene R, Vagg P. Manual for the state-trait anxiety inventory. Consulting Psychologists Press; Palo Alto, CA; 1983.
    1. Minde K, Shosenberg N, Morton P, Thompson J, Ripley J, Burns S. Self-help groups in a premature nursery-a controlled evaluation. J Pediatr. 1980;96:933–40. doi: 10.1016/S0022-3476(80)80586-5.
    1. Affleck G, Tennen H, Rowe J, Roscher B, Walker L. Effects of formal support on mothers’ adaptation to the hospital-to-home transition of high-risk infants: the benefits and costs of helping. Child Dev. 1989;60:488–501. doi: 10.1111/j.1467-8624.1989.tb02730.x.
    1. Kahn R, Zuckerman B, Bauchner H, Homer C, Wise P. Women’s health after pregnancy and child outcomes at age 3 years: a prospective cohort study. Am J Public Health. 2002;92:1312–8. doi: 10.2105/AJPH.92.8.1312.
    1. Chung E, McCollum K, Elo I, Lee H, Culhane J. Maternal depressive symptoms and infant health practices among low-income women. Pediatrics. 2004;113:e523–9. doi: 10.1542/peds.113.6.e523.
    1. Guttmann A, Dick P. Infant hospitalization and maternal depression, poverty and single parenthood-a population-based study. Child Care Health Dev. 2003;30:67–75. doi: 10.1111/j.1365-2214.2004.00390.x.
    1. Sills M, Shetterly S, Xu S, Magid D, Kempe A. Association between parental depression and children’s health care use. Pediatrics. 2007;119. 10.1542/peds.2006-2399.
    1. Weil C, Wade S, Bauman L, Lynn H, Mitchell H, Lavigne J. The relationship between psychosocial factors and asthma morbidity in inner-city children with asthma. Pediatrics. 1999;104:1274–80. doi: 10.1542/peds.104.6.1274.
    1. NICHD Early Child Care Research Network. Chronicity of maternal depressive symptoms, maternal sensitivity, and child functioning at 36 months. Dev Psychol. 1999;35:1297–310. doi: 10.1037/0012-1649.35.5.1297.
    1. Gooding J, Cooper L, Blaine A, Franck L, Howse J, Berns S. Family support and family-centered care in the neonatal intensive care unit: origins, advances, impact. Semin Perinatol. 2011;35:20–8. doi: 10.1053/j.semperi.2010.10.004.

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