Mothers treated in same room as preterm newborns experience less stress

Mothers who received postnatal care in the same room as their preterm infants had lower levels of stress upon discharge than mothers whose infants received standard neonatal care, data published in JAMA Network Open showed.

The prospective, multicenter cohort study also revealed these mothers were more involved in neonatal care.

Issues with maternal-newborn separation

According to the researchers, common neonatal care practices — including parent-child separation and, in the case of preterm births, NICU admission — strain a mother’s mental health postpartum. NICU admission specifically has been linked to adverse maternal mental health outcomes such as depression, anxiety and posttraumatic stress.

“Previous studies have shown that participation in care with a family integrated care (FICare) approach can alleviate maternal stress at discharge,” Nicole R. van Veenendaal, MD, MSc, a PhD candidate in the department of pediatrics and neonatology at OLVG in Amsterdam, and colleagues wrote.

“However, the exact mechanisms on how FICare and [single family rooms (SFRs)] accommodate a reduction in stress and what exact domains of participation in care are promoted and need further reinforcement remains to be elucidated,” they said. “Also, as not all units are able to change their architectural setting to a SFR design and because FICare can be implemented in open bay units, it is important to discern if active parent participation is a mediator for maternal mental health outcomes (such as anxiety and depression).”

Additionally, they noted that policies implemented during the COVID-19 pandemic accentuated the adverse effects of maternal-newborn separation.

“Parents have reported that restrictions limit their ability to bond with their infant, to participate in care and negatively impact breastfeeding as well,” they said.

Assessing mothers’ mental health

In the present study, van Veenendaal, also a PhD candidate at Amsterdam University Medical Centers, and colleagues assessed maternal mental health outcomes in 124 mothers of preterm infants who received FICare and 115 mothers whose infants received standard neonatal care in level 2 neonatal units in the Netherlands between May 19, 2017, and Jan. 8, 2020. All preterm infants stayed in the hospital for more than 7 days.

The researchers administered the Parental Stress Scale: NICU (PSS-NICU) to assess maternal stress at discharge, with higher scores — up to 130 — indicating higher stress levels. They also assessed maternal depression, self-efficacy, mother-newborn bonding and satisfaction with care through questionnaires.

FICare improves outcomes

Overall, PSS-NICU scores were lower among mothers who received FICare compared with those whose infants received standard neonatal care (adjusted mean difference [MD], 12.24; 95% CI, 18.44 to 6.04).

Specifically, they had lower stress scores related to infant behavior, sights and sounds (aMD, 5.819; 95% CI, 10.29 to 1.35); and lower stress scores related to parental role changes (aMD, –6.423; 95% CI, 8.91 to 3.937). They also had lower stress scores related to extreme stress caused by separation (aMD, 1.273; 95% CI, 1.835 to 0.712), with 24 (70.6%) of the 34 mothers who reported extreme stress being part of the standard neonatal care cohort.

Mothers in the FICare cohort were more likely to be present for at least 8 hours per day compared with those in the standard care cohort (84.7% vs. 36.5%; adjusted OR = 19.35; 95% CI, 8.13-46.08). They also spent more time with their infant and participated more in daily care, medical care, advocacy and leadership and comforting the infant.

Mediation analyses showed that active participation played a significant role in the association between less maternal depression and anxiety, better maternal-newborn bonding and higher maternal self-efficacy.

Satisfaction with care did not differ between the FICare model and standard neonatal care, the researchers wrote.

“These findings suggest that for maternal depression, mother-newborn bonding and maternal self-efficacy, specific attention should be pointed toward active maternal partnership and collaboration in neonatal care,” they said.

As for future research, van Veenendaal and colleagues suggested studies should investigate how hospitalization of a preterm infant impacts fathers and partners, as well as what zero separation means for this group.