Brady Sinead, Steinwurtzel Rochelle, Kim Rachel, Abascal Elena, Lane Mariellen, Brachio Sandhya
From the Division of Neonatal and Perinatal Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, N.Y.
Mailman School of Public Health, Columbia University, New York, N.Y.
Pediatr Qual Saf. 2023 Jul 10;8(4):e674. doi: 10.1097/pq9.0000000000000674. eCollection 2023 Jul-Aug.
Infants born to mothers with postpartum depression (PPD) are at risk for adverse developmental outcomes. Mothers of premature infants are 40% more likely to develop PPD when compared with the general population. Current published studies on implementing PPD screening in the Neonatal Intensive Care Unit (NICU) do not comply with the American Academy of Pediatrics (AAP) guideline, which recommends multiple screening points in the first year postpartum and includes partner screening. Our team implemented PPD screening that follows the AAP guideline and includes partner screening for all parents of infants admitted to our NICU beyond 2 weeks of age.
The Institute For Healthcare Improvement Model for Improvement was the framework for this project. Our initial intervention bundle included provider education, standardized identification of parents to be screened, and bedside screening performed by the nurse with social work follow-up. This intervention transitioned to weekly screening by phone by health professional students and the use of the electronic medical record for notification of team members of screening results.
Under the current process, 53% of qualifying parents are screened appropriately. Of the parents screened, 23% had a positive Patient Health Questionnaire-9 requiring referral for mental health services.
Implementing a PPD screening program that complies with the AAP standard is feasible within a Level 4 NICU. Partnering with health professional students greatly improved our ability to screen parents consistently. Given the high percentage of parents with PPD uncovered with appropriate screening, this type of program has a clear need within the NICU.
产后抑郁症（PPD）母亲所生的婴儿有发育不良的风险。与普通人群相比，早产儿母亲患PPD的可能性高40%。目前已发表的关于在新生儿重症监护病房（NICU）实施PPD筛查的研究不符合美国儿科学会（AAP）的指南，该指南建议在产后第一年进行多次筛查，并包括伴侣筛查。我们的团队实施了遵循AAP指南的PPD筛查，包括对入住我们NICU超过2周的婴儿的所有父母进行伴侣筛查。
医疗保健改进研究所的改进模型是本项目的框架。我们最初的干预方案包括提供者教育、对要筛查的父母进行标准化识别，以及由护士在床边进行筛查并由社会工作跟进。这种干预转变为健康专业学生通过电话每周进行筛查，并使用电子病历通知团队成员筛查结果。
在当前流程下，可以对53%符合条件的父母进行适当筛查。在接受筛查的父母中，23%的患者健康问卷-9呈阳性，需要转介接受心理健康服务。
在4级新生儿重症监护病房内实施符合AAP标准的PPD筛查计划是可行 的。与健康专业学生合作大大提高了我们持续筛查父母的能力。鉴于通过适当筛查发现患有PPD的父母比例很高，这种类型的计划在新生儿重症监护病房内显然是有必要的。
