Maternal stress and depressive symptoms associated with quality of developmental care in 25 Italian Neonatal Intensive Care Units: a cross sectional observational study.

BACKGROUND: Parents of very preterm infants are at great risk for experiencing stress and depression. The so called developmental care oriented approach used in Neonatal Intensive Care Units have beneficial effects for parents. However the actual level of developmental care may vary among units and little is known about how the routine adoption of developmental care affects maternal stress and depression. OBJECTIVES: To investigate the extent to which level of quality of developmental care routinely carried out in 25 tertiary Neonatal Intensive Care Units across Italy affects maternal stress and depression. PARTICIPANTS: 178 mothers of healthy very preterm infants with gestational age ≤29wk and/or birth weight ≤1500g and without documented neurologic pathologies were recruited consecutively. 180 full-term mothers were recruited as the control group. METHODS: To distinguish the quality of developmental care level, each unit was assessed using a specifically developed questionnaire. We compared negative emotional states of mothers by splitting the 25 Neonatal Intensive Care Units into units with high-care and low-care based on median splits for two main care factors: (1) The Infant Centered Care index (consisting of measures of parent involvement, including ability to room in, frequency and duration of kangaroo care and nursing interventions aimed at decreasing infant energy expenditure and promoting autonomic stability). (2) The Infant Pain Management index (consisting of measures to decrease painful experiences including pharmacologic and nursing care practices). Maternal stress was assessed by the Parental Stressor Scale: Neonatal Intensive Care Unit questionnaire. Maternal depressive symptomatology was assessed by the Edinburgh Postnatal Depression Scale questionnaire. RESULTS: Preterm mothers from low-care units in the Infant Pain Management reported higher scores in their perception of stress associated with behavior and appearance of the infant than mothers from high-care units (p=0.05). Preterm mothers from high-care units in the Infant Pain Management reported a depressive symptomatology score average similar to that reported by full-term mothers. No significant Infant Centered Care effect was found both for maternal stress and depression. CONCLUSIONS: The findings suggest that implementing more practices useful to reduce infants' painful experience can mitigate the stress and depressive symptomatology of the preterm mothers.

Measuring maternal stress and perceived support in 25 Italian NICUs.

AIMS: To determine the validity and reliability of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) and the Nurse Parental Support Tool (NPST) for use with Italian parents; to investigate to which extent demographic variables and/or situational factors affect NICU-related maternal stress. METHODS: Mothers (N = 156) of very preterm (VPT) infants from 25 Italian NICUs completed a socio-demographic form, the PSS: NICU and the NPST at discharge. Psychometric properties of both tools were evaluated. RESULTS: High internal consistency and split-half reliability were found for both measures. The multi-dimensional structure of the PSS:NICU was confirmed. Alteration in parental role emerged as the greatest source of NICU-related stress. Length of stay in NICU and familiar socio-economic status explained partial variance in the PSS: NICU scores. NPST score mitigates the stress because of the infant's appearance and behaviour, but not that related to the parental role alteration. CONCLUSIONS: PSS: NICU and NPST demonstrated adequate psychometric properties in a large sample of Italian mothers. The need for a psychologically informed support to NICU mothers is suggested.

The sleep protection in the preterm infants.

The importance of sleep in the development is only now beginning to be understood: sleep and established sleep cycles have an important role in the normal neurosensory and cortex development. The biological basis of sleep organization has been highlighted by several studies however environmental differences can affect the sleep patterns in preterm infants in the NICU. Sleep disorders are related to several physiological conditions but it is important to know the relationship between sleep organization and neurocognitive and socio-emotional outcomes. From the recent literature it is possible to find out potentially better practices that preserve and promote infant sleep in the NICU.