Montirosso Rosario, Fedeli Claudia, Del Prete Alberto, Calciolari Guido, Borgatti Renato
0-3 Centre for the Study of Social Emotional Development of the At-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
0-3 Centre for the Study of Social Emotional Development of the At-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
Int J Nurs Stud. 2014 Jul;51(7):994-1002. doi: 10.1016/j.ijnurstu.2013.11.001. Epub 2013 Nov 21.
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.
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.
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.
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.
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.
The findings suggest that implementing more practices useful to reduce infants' painful experience can mitigate the stress and depressive symptomatology of the preterm mothers.
极早产儿的父母承受压力和抑郁的风险极高。新生儿重症监护病房采用的所谓以发育照护为导向的方法对父母有有益影响。然而，各病房发育照护的实际水平可能存在差异，对于常规采用发育照护如何影响母亲的压力和抑郁，人们了解甚少。
调查意大利25家三级新生儿重症监护病房常规开展的发育照护质量水平对母亲压力和抑郁的影响程度。
连续招募了178名健康极早产儿的母亲，这些婴儿的孕周≤29周和/或出生体重≤1500克，且无神经病理学记录。招募了180名足月儿母亲作为对照组。
为区分发育照护水平的质量，使用专门编制的问卷对每个病房进行评估。我们根据两个主要照护因素的中位数分割，将25家新生儿重症监护病房分为高照护病房和低照护病房，比较母亲的负面情绪状态：（1）以婴儿为中心的照护指数（包括父母参与度的衡量指标，如母婴同室能力、袋鼠式护理的频率和时长以及旨在减少婴儿能量消耗和促进自主稳定的护理干预措施）。（2）婴儿疼痛管理指数（包括减少疼痛经历的措施，如药物和护理实践）。通过父母压力源量表：新生儿重症监护病房问卷评估母亲的压力。通过爱丁堡产后抑郁量表问卷评估母亲的抑郁症状。
在婴儿疼痛管理方面，来自低照护病房的早产母亲比来自高照护病房的母亲在对与婴儿行为和外貌相关的压力感知上得分更高（p=0.05）。在婴儿疼痛管理方面，来自高照护病房的早产母亲报告的抑郁症状评分平均与足月儿母亲报告的相似。在母亲压力和抑郁方面均未发现以婴儿为中心的照护有显著影响。
研究结果表明，实施更多有助于减少婴儿疼痛经历的措施可以减轻早产母亲的压力和抑郁症状。
