The experience of having a very preterm baby admitted to NICU is enormously challenging for families. An infant admitted to Neonatal Intensive Care Unit (NICU) is critically unwell and may face a serious, long term health complications such as brain injury or lung disease. Parents can find themselves catapulted into the complex new world of the neonatal ward. The experience of the preterm birth is also usually unexpected, and typically frightening. The life of the baby or the mother may be at risk, or both.
Depression, Anxiety and Posttraumatic Stress Symptoms
It is hardly surprising then, that parents with a very preterm infant (<32 weeks) have higher rates of symptoms of depression, anxiety, and trauma-related responses, than parents of healthy infants born at term. However, it is concerning that recent research found that these mental health symptoms remained elevated for approximately one fifth of mothers and approximately one fifth of fathers two years after the birth of their child (Pace, Anderson, Lee, Spittle & Treyvaud, 2020).
What’s Good for Parents is Good for Infants, Including Pre-Term Infants
There is an extensive body of research in infant and child mental health, showing that interventions to support parents with mental health difficulties is good for everyone. The same is also true for families with preterm infants.
Recommendations for Supporting Parents following Pre Term Birth
How should this support be structured?
Treyvaud, Spittle, Anderson and O’Brien (2019) developed a series of recommendations which were based upon a review of clinical guidelines, intervention studies and parent outcomes research.
The recommended that support for parents in the NICU after preterm birth ought to be multilayered, with consideration of the mental health needs of the parent, the emotional and physical health of the infant, as well as support for the parent-infant relationship.
They make the following suggestions regarding interventions for families following preterm birth:
• Screening Programs – to screen for mental health symptoms and psychosocial risk amongst all parents of infants born preterm in the NICU, however there must also be a capacity for intervention and response when required.
• Individualised and/or Group Psychological Support for all parents within the NICU.
• Processes for referral to access specialised assessment, intervention or ongoing psychological support following discharge which is linked to internal and external services.
• Peer-to-peer support that is overseen by and integrated into the NICU.
• Family Centred Care approaches within the hospital which promote the provision of individualised psycho-social support to parents. This approach also encourages parents to be involved in the direct delivery of care to their baby.
• Support for NICU staff (including psychoeducation) who have high levels of contact with parents.
• Psychological support for the parent-infant relationship is integral and may also be effective when integrated with early intervention programs that focus on enhancing infant development.
After Discharge from Hospital:
Families also often require ongoing support following discharge from NICU. This should include screening, follow-up assessment, intervention, and/or referral to specialist ongoing psychological support. A multidisciplinary approach is often warranted and of great benefit.
Summary:
Given the emphasis upon optimising development in preterm infants, where there is already a heightened risk of developmental and emotional difficulties, a focus upon strengthening parent-infant relationships presents a window for enhancing outcomes in early intervention programs.
Pace CC, Anderson PJ, Lee KJ, Spittle AJ, Treyvaud K. Posttraumatic Stress Symptoms in Mothers and Fathers of Very Preterm Infants Over the First 2 Years. J Dev Behav Pediatr. 2020 Oct-Nov;41(8):612-618. doi: 10.1097/DBP.0000000000000828. PMID: 32576786
Treyvaud K, Spittle A, Anderson P & O’Brien K. (2019) A multilayered approach is needed in the NICU to support parents after the preterm birth of their infant, Early Human Development, Vol 139, 104838, ISSN 0378-3782, https://doi.org/10.1016/j.earlhumdev.2019.104838.
