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Separation-related stress in the NICU is a worldwide issue for parents: Meta-Analytic Evidence

Updated: Mar 11, 2021

Mothers and fathers whose baby's born preterm are exposed to a large number of potential stressors, including the physical environment of the intensive care unit (lights, sounds), the fragile appearance of their baby and the partial or complete limitation of caregiving activities due to precocious parent-infant separation.

In the early 90s, Margaret Shandor Miles developed a questionnaire - namely, the Parental Stressor Scale for NICU (PSS:NICU) - that is now well-known among NICU professionals and researchers. It has been translated in many languages and used in clinical units and research projects across the entire world. The PSS:NICU provides quantiative measures of parental stress for three or four dimensions (two versions of the tool are available): sights and sounds (physical environment), infant behavior and appearance, parental role alteration, and (less often studied) staff behavior and communication. During the last thirty years, PSS:NICU research accumulated so we decided to run a meta-analytic study on the findings obtained using this tool among different countries.

More than 50 studies were included, providing evidence of parents' stress in the NICU environment of more than 15 countries. The findings suggest that the stress related to the parental role alteration - which means not being able to perform caregiving acts, soothing the baby, touching him/her, the physical and emotional separation from the newborn - is the highest source of burden for both mothers and fathers of preterm babies admitte to the NICU. This stressor is systematically and significanly higher than the other stressors targetted by the PSS:NICU. Individual differences were also present and they may be at least partially explained by the lenght of stay in the NICU, the cultural values of the NICU and social features of different countries. Notably, African and Asiatic countries were under-represented in this meta-analysis, suggesting that a lot stilll nees to be done on a large scale to promote better care for parents of infants admitted to the NICU.

Parents' stress in the NICU is a worldwide issue and it is greatly affected by the partial access of parents to caregiving soon after the delivery of their baby. At the same time, the promotion of parent-infant closeness is crucial for the well-being of the preterm baby and his/her family. The availability of validated tools to assess stress in parents of infants admitted to the NICU is a step forward. Adequate actions need to be planned and performed at the local, clinical and policy levels to provide mothers and fathers of preterm babies otpimal psychological, cognitive and emotional support during and after the NICU hospitalization.


Full citation:

Caporali C, Pisoni C, Gasparini L, Ballante E, Zecca M, Orcesi S, & Provenzi L (2020). A global perspective on parental stress in the neonatal intensive care unit: a meta-analytic study. Journal of perinatology, in press.

Want to know more on "parent-infant closeness" in the NICU environment?

Thomson, G., Flacking, R., George, K., Feeley, N., Haslund-Thomsen, H., De Coen, K., Schmie V, Provenzi L, & Rowe, J. (2020). Parents' experiences of emotional closeness to their infants in the neonatal unit: A meta-ethnography. Early Human Development, 105155.

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