Download PDF
Am J Perinatol 2021; 38(11): 1201-1208
DOI: 10.1055/s-0041-1731649
Original Article

Impacts of Neonatal Hospitalization on Families during the 2019 Coronavirus Pandemic

Ashlee J. Vance 
1   National Clinician Scholars Program, University of Michigan, School of Nursing, Ann Arbor, Michigan
,
Kathryn J. Malin
2   College of Nursing, Marquette University, Milwaukee, Wisconsin
,
Bingxin Chen
3   School of Nursing, University of Michigan, Ann Arbor, Michigan
,
Clayton J. Shuman 
3   School of Nursing, University of Michigan, Ann Arbor, Michigan
,
Tiffany A. Moore
4   College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Objective Limited data are available regarding family and financial well-being among parents whose infants were hospitalized during the 2019 coronavirus (COVID-19) pandemic. The study objective was to evaluate the family and financial well-being of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) during COVID-19.

Study Design Parents were recruited for this online, cross-sectional survey via support groups on social media. Data collection was completed between May 18, 2020 and July 31, 2020. The final sample consisted of 178 parents, who had an infant hospitalized in an NICU between February 1, 2020 and July 31, 2020. The primary outcomes were impact on family life and financial stability, as measured by the Impact on Family scale, an instrument that evaluates changes to family life as a result of infant or childhood illness.

Results Of the 178 parent respondents, 173 (97%) were mothers, 107 (59.4%) were non-Hispanic White, and 127 (69.5%) of the infants were born prematurely. Parents reported significant family impact and greater financial difficulty. Extremely premature infants, lower household income, parent mental health, and lower parental confidence were predictive of greater impacts on family life.

Conclusion Parents reported significant family and financial impacts during their infant's hospitalization amid COVID-19. Further studies are needed to guide clinical practice and inform family-supportive resources that can mitigate consequences to family well-being.

Key Points

  • Impact of infant hospitalization in the context of COVID-19 is largely unknown.

  • In a cohort of NICU parents during COVID-19, they reported changes to family life and finances.

  • Greater impacts were reported by parents with lower income, confidence, and very premature infants.

Keywords

neonatal intensive care - COVID-19 - parents - financial well-being


Publication History

Received: 18 January 2021

Accepted: 25 May 2021

Article published online:
05 July 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Schmöker A, Flacking R, Udo C, Eriksson M, Hellström-Westas L, Ericson J. Longitudinal cohort study reveals different patterns of stress in parents of preterm infants during the first year after birth. Acta Paediatr 2020; 109 (09) 1778-1786
    CrossrefPubMedGoogle Scholar
  • 2 Holditch-Davis D, Miles MS. Mothers' stories about their experiences in the neonatal intensive care unit. Neonatal Netw 2000; 19 (03) 13-21
    CrossrefPubMedGoogle Scholar
  • 3 Ahmad KA, Darcy-Mahoney A, Kelleher AS, Ellsbury DL, Tolia VN, Clark RH. Longitudinal survey of COVID-19 burden and related policies in U.S. neonatal intensive care units. Am J Perinatol 2020
    PubMedGoogle Scholar
  • 4 Berry JG, Hall M, Neff J. et al. Children with medical complexity and Medicaid: spending and cost savings. Health Aff (Millwood) 2014; 33 (12) 2199-2206
    CrossrefPubMedGoogle Scholar
  • 5 Lean RE, Rogers CE, Paul RA, Gerstein ED. NICU hospitalization: long-term implications on parenting and child behaviors. Curr Treat Options Pediatr 2018; 4 (01) 49-69
    CrossrefPubMedGoogle Scholar
  • 6 Loewenstein K, Barroso J, Phillips S. The experiences of parents in the neonatal intensive care unit: an integrative review of qualitative studies within the transactional model of stress and coping. J Perinat Neonatal Nurs 2019; 33 (04) 340-349
    Google Scholar
  • 7 Vazquez V, Cong X. Parenting the NICU infant: a meta-ethnographic synthesis. Int J Nurs Sci 2014; 1 (03) 281-290
    PubMedGoogle Scholar
  • 8 World Health Organization. Breastfeeding and COVID-19. Accessed 2020 at: https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19
    PubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA. et al. Vertical transmission of coronavirus disease 19 (COVID-19) from infected pregnant mothers to neonates: a review. Fetal Pediatr Pathol 2020; 39 (03) 246-250
    CrossrefPubMedGoogle Scholar
  • 11 Centers for Disease Control and Prevention. Evaluation and Management considerations for Neonates. Accessed 2020 at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-newborns.html
    PubMedGoogle Scholar
  • 12 Dumitriu D, Emeruwa UN, Hanft E. et al. Outcomes of neonates born to mothers with severe acute respiratory syndrome coronavirus 2 infection at a large medical center in New York City. JAMA Pediatr 2020
    PubMedGoogle Scholar
  • 13 Vance AJ, Duy J, Laventhal N, Iwashyna TJ, Costa DK. Visitor guidlines in US children's hosptials during COVID-19, Hosp Pediatr. 2020 In press
    PubMedGoogle Scholar
  • 14 Aagaard H, Hall EO. Mothers' experiences of having a preterm infant in the neonatal care unit: a meta-synthesis. J Pediatr Nurs 2008; 23 (03) e26-e36
    CrossrefPubMedGoogle Scholar
  • 15 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 2020
    PubMedGoogle Scholar
  • 16 Salvatore CM, Han J-Y, Acker KP. et al. Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study. Lancet Child Adolesc Health 2020; 4 (10) 721-727
    CrossrefPubMedGoogle Scholar
  • 17 Gateau K, Song A, Vanderbilt DL. et al. Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21 (01) 48
    CrossrefPubMedGoogle Scholar
  • 18 O'Donovan A, Nixon E. “Weathering the storm:” mothers' and fathers' experiences of parenting a preterm infant. Infant Ment Health J 2019; 40 (04) 573-587
    CrossrefPubMedGoogle Scholar
  • 19 Treyvaud K. Parent and family outcomes following very preterm or very low birth weight birth: a review. Semin Fetal Neonatal Med 2014; 19 (02) 131-135
    CrossrefPubMedGoogle Scholar
  • 20 Singer LT, Salvator A, Guo S, Collin M, Lilien L, Baley J. Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA 1999; 281 (09) 799-805
    CrossrefPubMedGoogle Scholar
  • 21 Roque ATF, Lasiuk GC, Radünz V, Hegadoren K. Scoping review of the mental health of parents of infants in the NICU. J Obstet Gynecol Neonatal Nurs 2017; 46 (04) 576-587
    CrossrefPubMedGoogle Scholar
  • 22 Lakshmanan A, Agni M, Lieu T. et al. The impact of preterm birth <37 weeks on parents and families: a cross-sectional study in the 2 years after discharge from the neonatal intensive care unit. Health Qual Life Outcomes 2017; 15 (01) 38
    CrossrefPubMedGoogle Scholar
  • 23 Werner H, Latal B, Valsangiacomo Buechel E, Beck I, Landolt MA. The impact of an infant's severe congenital heart disease on the family: a prospective cohort study. Congenit Heart Dis 2014; 9 (03) 203-210
    CrossrefPubMedGoogle Scholar
  • 24 Franck LS, Shellhaas RA, Lemmon M. et al; Neonatal Seizure Registry study group. Associations between infant and parent characteristics and measures of family well-being in neonates with seizures: a cohort study. J Pediatr 2020; 221: 64-71 .e4, e64
    CrossrefPubMedGoogle Scholar
  • 25 Raina P, O'Donnell M, Schwellnus H. et al. Caregiving process and caregiver burden: conceptual models to guide research and practice. BMC Pediatr 2004; 4: 1
    CrossrefPubMedGoogle Scholar
  • 26 Stein REK, Jessop DJ. The impact on family scale revisited: further psychometric data. J Dev Behav Pediatr 2003; 24 (01) 9-16
    CrossrefPubMedGoogle Scholar
  • 27 Power K. The COVID-19 pandemic has increased the care burden of women and families. Sustainability: Science, Practice and Policy. 2020; 16 (01) 67-73
    CrossrefPubMedGoogle Scholar
  • 28 Fonseca A, Nazaré B, Canavarro MC. The role of satisfaction with social support in perceived burden and stress of parents of six-month-old infants with a congenital anomaly: Actor and partner effects. J Child Health Care 2014; 18 (02) 178-191
    CrossrefPubMedGoogle Scholar
  • 29 Löwe B, Wahl I, Rose M. et al. A 4-item measure of depression and anxiety: validation and standardization of the patient health questionnaire-4 (PHQ-4) in the general population. J Affect Disord 2010; 122 (1-2): 86-95
    CrossrefPubMedGoogle Scholar
  • 30 Crncec R, Barnett B, Matthey S. Development of an instrument to assess perceived self-efficacy in the parents of infants. Res Nurs Health 2008; 31 (05) 442-453
    CrossrefPubMedGoogle Scholar
  • 31 Vance AJ, Pan W, Malcolm WH, Brandon DH. Development of parenting self-efficacy in mothers of high-risk infants. Early Hum Dev 2020; 141: 104946
    CrossrefPubMedGoogle Scholar
  • 32 Kohlhoff J, Barnett B. Parenting self-efficacy: links with maternal depression, infant behaviour and adult attachment. Early Hum Dev 2013; 89 (04) 249-256
    CrossrefPubMedGoogle Scholar
  • 33 Latour JM, Duivenvoorden HJ, Hazelzet JA, van Goudoever JB. Development and validation of a neonatal intensive care parent satisfaction instrument. Pediatr Crit Care Med 2012; 13 (05) 554-559
    CrossrefPubMedGoogle Scholar
  • 34 Lake ET, Smith JG, Staiger DO. et al. Parent satisfaction with care and treatment relates to missed nursing care in neonatal intensive care units. Front Pediatr 2020; 8: 74
    CrossrefPubMedGoogle Scholar
  • 35 Zhang Z. Variable selection with stepwise and best subset approaches. Ann Transl Med 2016; 4 (07) 136
    CrossrefPubMedGoogle Scholar
  • 36 Vonneilich N, Lüdecke D, Kofahl C. The impact of care on family and health-related quality of life of parents with chronically ill and disabled children. Disabil Rehabil 2016; 38 (08) 761-767
    CrossrefPubMedGoogle Scholar
  • 37 Kristensen IH, Simonsen M, Trillingsgaard T, Pontoppidan M, Kronborg H. First-time mothers' confidence mood and stress in the first months postpartum. A cohort study. Sex Reprod Healthc 2018; 17: 43-49
    CrossrefPubMedGoogle Scholar
  • 38 Holditch-Davis D, Santos H, Levy J. et al. Patterns of psychological distress in mothers of preterm infants. Infant Behav Dev 2015; 41: 154-163
    CrossrefPubMedGoogle Scholar
  • 39 Stephens BE, Bann CM, Poole WK, Vohr BR. Neurodevelopmental impairment: predictors of its impact on the families of extremely low birth weight infants at 18 months. Infant Ment Health J 2008; 29 (06) 570-587
    CrossrefPubMedGoogle Scholar
  • 40 Glazer KB, Sofaer S, Balbierz A, Wang E, Howell EA. Perinatal care experiences among racially and ethnically diverse mothers whose infants required a NICU stay. J Perinatol 2020
    PubMedGoogle Scholar
  • 41 Amorim M, Alves E, Kelly-Irving M, Silva S. Needs of parents of very preterm infants in neonatal intensive care units: a mixed methods study. Intensive Crit Care Nurs 2019; 54: 88-95
    CrossrefPubMedGoogle Scholar
  • 42 National Association of Neonatal Nurses, National Perinatal Assocation. Shared decision-making protects mothers + infants during COVID-19. Published May, 2020. Accessed October, 2020 at: http://nann.org/uploads/About/PositionPDFS/flyer_%20NANN%20%20NPA%20position%20statement.pdf
    PubMedGoogle Scholar
  • 43 Association of Women's Health Obsetric and Neonatal Nurses, National Association of Neonatal Nurses, National Perinatal Assocation. Essential Care in the NICU during the COVID-19 Pandemic. Published 2021. Accessed March 15, 2021 at: http://nann.org/uploads/About/PositionPDFS/Consensus_Statement_AWHONN_NANN_NPA_final.pdf
    PubMedGoogle Scholar
  • 44 Benedict C, Hahn AL, Diefenbach MA, Ford JS. Recruitment via social media: advantages and potential biases. Digit Health 2019; 5: 2055207619867223
    CrossrefPubMedGoogle Scholar