Parent participation in the neonatal intensive care unit: Predictors and relationships to neurobehavior and developmental outcomes

Abstract

Objective To 1) define predictors of parent presence, any holding, holding in arms, and skin-to-skin care in the NICU and 2) investigate the relationships between parent participation and a) early neurobehavior and b) developmental outcomes at age 4 to 5 years among preterm infants. Methods Eighty-one preterm infants born ≤32 weeks estimated gestational age were prospectively enrolled within one week of life in a level III-IV NICU. Parent (maternal and paternal) presence and holding (including holding in arms and skin-to-skin care) were tracked throughout NICU hospitalization. Neurobehavior at term equivalent age and development at 4 to 5 years were assessed using standardized assessments. Results The median number of days per week parents were documented to be present over NICU hospitalization was 4.0 (IQR=2.4–5.8) days; days held per week 2.8 (IQR=1.4–4.3) days [holding in arms days per week was 2.2 (IQR=1.2– 3.2) days and parent skin-to-skin care days per week was 0.2 (IQR=0.0–0.7) days]. More parent presence was observed among mothers who were Caucasian, married, older, or employed and among those who had fewer children, familial support and provided breast milk (p<0.05). More holding was observed in infants with fewer medical interventions (p<0.05) and among those who were Caucasian, had a father who was employed, had fewer children and family support (p<0.05). More parent holding in the NICU was related to better reflex development at term age (p=0.02). More parent skin-to-skin care was related to better infant reflexes (p=0.03) and less asymmetry (p=0.04) at term and better gross motor development (p=0.02) at 4–5 years. Discussion Social and medical factors appear to impact parent presence, holding, and skin-to-skin care in the NICU. Parent holding is related to better developmental outcomes, which highlights the importance of engaging families in the NICU.