Neonatal Intensive Care Unit Infants, Parental Stress, Couple and Family Impact
Authors:   , Grunberg Victoria A. , Geller Pamela A. 
Published: July 2021

The birth of a child is an exciting and challenging time for parents. The first few years following birth involve an adjustment period as parents work together to balance work, family, infant care, and self-care. Approximately 7 - 15% of parents will have an infant who will spend some amount of time in a Neonatal Intensive Care Unit (NICU). These parents experience the typical stressors associated with parenthood plus the additional stress of worrying about their infant's survival, development, and/or long-term health. After NICU discharge, parents are sent home to care for an ill and/or preterm infant and often continue to worry about rehospitalizations, ongoing health issues, and the long-term consequences of the experience. The impact of the NICU experience and subsequent infant health issues on parental and family outcomes is an understudied area that merits research attention. The current study examined how the NICU experience and subsequent infant health problems that may follow during the first three years after discharge affects parental stress, couple functioning, and family dynamics. A variable known to attenuate stress and family outcomes (i.e., family resources) was included to study the contribution of this factor. Parents with infants who had been discharged from the NICU six months to three years ago were recruited via the Internet and posted flyers (N = 199). Parents reported objective indicators of their infants' health during the NICU admission and at the present time, parenting stress, family burden, couple functioning, and access to family resources. Both parents were invited to participate to gain a more comprehensive picture of perspectives and experiences, and to compare responses of mothers and fathers. However, women (n = 182; 91.5%) greatly outnumbered men (n = 17; 8.5%) almost eleven to one in the sample making comparisons of mothers and fathers statistically underpowered. Multivariate regression analyses revealed that a shorter length of stay in the NICU, less infant rehospitalizations, and additional infant diagnoses following discharge were significant positive predictors of increased parental stress. Moreover, a higher number of medical devices used by the infant at discharge and fewer infant rehospitalizations were associated with poorer couple functioning. Infant use of extracorporeal membrane oxygenation (ECMO) during the NICU stay, a greater number of medical devices used by the infant during the NICU stay, the more specialists seen in the first year post-discharge, and the more medications currently prescribed, were all associated with greater family burden. Family resources did not significantly moderate (i.e., change or strengthen) the relationships between infant health and each outcome; however, fewer family resources was associated with increased parental stress, poorer couple functioning, and greater family burden. Analysis of covariance (ANCOVA) was used to examine sex differences and although no differences were found, analyses were greatly underpowered and should be interpreted with caution. Results suggest that infant health severity, the associated burden of care, and family resources are important contributors for parental and family adjustment. Family-focused interventions that incorporate information and skills on managing their child's health issues, communication between medical providers and parents, transitioning home from the NICU, ways to adaptively coping strategies, and ways to overcome barriers to resources and treatment may be effective mechanisms to prevent negative psychosocial sequelae among NICU parents and families following discharge. Additional implications and future directions are discussed.