The NICU during COVID-19 Pandemic: Impact on Maternal Pediatric Medical Traumatic Stress (PMTS)

Abstract

Objective The objective of this paper was to assess how hospital and outpatient clinic policies changes due to the coronavirus disease 2019 (COVID-19) pandemic impact pediatric medical traumatic stress (PMTS) symptoms in mothers of newborns admitted in a neonatal intensive care unit (NICU).

Study Design Observational case-control study included the comparison between mothers of infants admitted in the NICU at birth during the COVID-19 pandemic and mothers of infants admitted in the NICU before the COVID-19 pandemic. The control group was selected matching 1:1 with the study group for the following infants' clinical variables: gender, type of pathology, gestational age, weight at birth, day of recovery, ventilator time days, and associated malformations. The Italian version of the Impact of Event Scale—Revised (IES-R) was used as a measure of PMTS.

Result Mothers of the study group (50) scored significantly higher than mothers of the control group on three of four scales of IES-R (“IES-R total”: F = 6.70; p = 0.011; IES-R subscale “intrusion”: F = 7.45; p = 0.008; IES-R subscale “avoidance”: F = 8.15; p = 0.005). A significantly higher number of mothers in the study group scored above the IES-R total clinical cut-off compared with mothers of control group (72 vs. 48%; Chi² = 6.00; p = 0.012).

Conclusion The COVID-19 pandemic acted as superimposed stress in mothers of newborns admitted in the NICU at birth determining high levels of PMTS. Clinicians and researchers should identify and implement novel strategies to provide family-centered care during the COVID-19 pandemic and beyond.

Key Points

• COVID-19 acted as superimposed stress on NICU population.

• PMTS in mothers got significantly worse during the COVID-19 pandemic.

• Alert on long-term consequences on child development.

Keywords

pediatric medical traumatic stress - NICU - COVID-19 - maternal psychological distress

Publication History

Received: 09 September 2021

Accepted: 07 December 2021

Accepted Manuscript online:
09 December 2021

Article published online:
18 January 2022

• References

• 1 Darcy Mahoney A, White RD, Velasquez A, Barrett TS, Clark RH, Ahmad KA. Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019. J Perinatol 2020; 40 (Suppl. 01) 36-46
• 2 Erdei C, Liu CH. The downstream effects of COVID-19: a call for supporting family wellbeing in the NICU. J Perinatol 2020; 40 (09) 1283-1285
• 3 Bolger N, DeLongis A, Kessler RC, Wethington E. The contagion of stress across multiple roles. J Marriage Fam 1989; 51: 175-183
• 4 Davidson JE, Aslakson RA, Long AC. et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 2017; 45 (01) 103-128
• 5 Aite L, Bevilacqua F, Zaccara A, La Sala E, Gentile S, Bagolan P. Seeing their children in pain: symptoms of posttraumatic stress disorder in mothers of children with an anomaly requiring surgery at birth. Am J Perinatol 2016; 33 (08) 770-775
• 6 Rose D, Harrison E. Social Class in Europe: An Introduction to The European Socio-economic Classification. London: Routledge; 2010
• 7 Weiss DS, Marmar CR. The impact of event scale-revised. In Wilson JP, Kean TM, eds. Assessing Psychological Trauma and PTSD. New York, NY: Guilford; 1997: 399-411
• 8 Craparo G, Faraci P, Rotondo G, Gori A. The Impact of Event Scale—Revised: psychometric properties of the Italian version in a sample of flood victims. Neuropsychiatr Dis Treat 2013; 9: 1427-1432
• 9 Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med 1979; 41 (03) 209-218
• 10 Rogers CE, Kidokoro H, Wallendorf M, Inder TE. Identifying mothers of very preterm infants at-risk for postpartum depression and anxiety before discharge. J Perinatol 2013; 33 (03) 171-176
• 11 Baley J. Commitee on fetus and newborn. Committee on fetus and newborn. Skin-to-skin care for term and preterm infants in the neonatal ICU. Pediatrics 2015; 136 (03) 596-599
• 12 Conde-Agudelo A, Díaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2016; 8 (08) CD002771
• 13 Welch MG, Firestein MR, Austin J. et al. Family nurture intervention in the neonatal intensive care unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial. J Child Psychol Psychiatry 2015; 56 (11) 1202-1211
• 14 Bevilacqua F, Morini F, Ragni B. et al. Pediatric medical traumatic stress (PMTS) in parents of newborns with a congenital anomaly requiring surgery at birth. J Pediatr Surg 2021; 56 (03) 471-475
• 15 Franck LS, O'Brien K. The evolution of family-centered care: from supporting parent-delivered interventions to a model of family integrated care. Birth Defects Res 2019; 111 (15) 1044-1059
• 16 Evans T, Whittingham K, Sanders M, Colditz P, Boyd RN. Are parenting interventions effective in improving the relationship between mothers and their preterm infants?. Infant Behav Dev 2014; 37 (02) 131-154
• 17 Zaka A, Shamloo SE, Fiorente P, Tafuri A. COVID-19 pandemic as a watershed moment: a call for systematic psychological health care for frontline medical staff. J Health Psychol 2020; 25 (07) 883-887
• 18 Lemmon ME, Chapman I, Malcolm W. et al. Beyond the first wave: consequences of Covid-19 on high-risk infants and families. Am J Perinatol 2020; 37 (12) 1283-1288
• 19 Umberson D, Pudrovska T, Reczek C. Parenthood, childlessness, and well-being: a life course perspective. J Marriage Fam 2010; 72 (03) 612-629
• 20 Feinberg ME. The internal structure and ecological context of coparenting: a framework for research and intervention. Parent Sci Pract 2003; 3 (02) 95-131
• 21 Liu CH, Doan SN. Psychosocial stress contagion in children and families during the COVID-19 pandemic. Clin Pediatr (Phila) 2020; 59 (9-10): 853-855
• 22 Smith VC, Steelfisher GK, Salhi C, Shen LY. Coping with the neonatal intensive care unit experience: parents' strategies and views of staff support. J Perinat Neonatal Nurs 2012; 26 (04) 343-352
• 23 Feldman R. Sensitive periods in human social development: new insights from research on oxytocin, synchrony, and high-risk parenting. Dev Psychopathol 2015; 27 (02) 369-395
• 24 Mehler K, Wendrich D, Kissgen R. et al. Mothers seeing their VLBW infants within 3 h after birth are more likely to establish a secure attachment behavior: evidence of a sensitive period with preterm infants?. J Perinatol 2011; 31 (06) 404-410
• 25 Litmanovitz I, Silberstein D, Butler S, Vittner D. Care of hospitalized infants and their families during the COVID-19 pandemic: an international survey. J Perinatol 2021; 41 (05) 981-987
• 26 Pineda R, Bender J, Hall B, Shabosky L, Annecca A, Smith J. Parent participation in the neonatal intensive care unit: predictors and relationships to neurobehavior and developmental outcomes. Early Hum Dev 2018; 117: 32-38