NICU Babies' Next Steps
Authors:   , Grunberg Victoria A. , Geller Pamela A 
Published: December 2021

Many infants (7-15%) spend time in a Neonatal Intensive Care Unit (NICU) and continue to experience ongoing medical issues and neurodevelopmental impairments after discharge. Parents of medically complex children report higher levels of psychological distress (e.g., depression, PTSD), exhibit more intrusive parenting styles, and report greater family burden compared to parents of healthy children. Additionally, greater family burden is associated with lower child developmental quotient. NICU infants impact the relationship and cooperation between parents, which has implications for children's' social-emotional development. Current literature highlights that infant medical issues and parental psychosocial functioning influence infant development. However, the direct and indirect relationships among relevant infant and family biopsychosocial variables remain unclear, particularly among infants with a variety of complex medical conditions within the first two years following NICU hospitalization. The current study assessed hypothesized relationships among infant medical risk, parental psychological distress, parenting style, couple functioning, parenting alliance, family burden, and access to resources, and assess whether and to what extent they contribute to infant cognitive and socio-emotional development. Eligible participants included parents of singleton infants who are 1.5 - 2.5 years old (adjusted gestational age) and seen at The Children's Hospital of Philadelphia (CHOP) Neonatal Follow-Up Program (NFUP) at Buerger. Participants were at least 18 years old, speak and read English, and were in an intimate relationship with their partner at the time of the child's NICU admission and cohabitating with partner and child since discharge. Eligible parents were contacted by phone to inquire about interest. Interested parents arrived at CHOP NFUP at Buerger 30 minutes prior to their infant's appointment to provide informed consent and complete self-report measures. Infant medical risk, cognitive development, and socio-emotional development were gleaned from medical records and developmental assessments from the medical chart. Structural equation comparative models were tested to best capture the data, as informed by current literature. Findings revealed that increased infant medical severity at discharge was directly associated with greater family impact and infant social-cognitive development two years later. Greater family resources had a direct effect with less family impact, less parental trauma, better couple functioning, better parenting alliance, and better infant social-cognitive development. More parental trauma was associated with more negative parenting styles and poorer couple functioning, which in turn, negatively impacted parenting alliance and then positive parenting styles. Together, findings provide greater insight into how family factors, including availability of basic needs, money, and time, directly impact parental mental health, parent-child interactions, and child development. This work suggests that medical providers, clinicians, and researchers should consider targeting parental trauma and access to resources, including time, to optimize family and infant outcomes.