Parenting the Premature Infant: Potential Iatrogenesis from the Neonatal Intensive Care Experience

(1) Developmental outcomes of premature infants are associated with the quality of the home environment and the level of parenting skills the family possesses. Successful development of the parenting role may be negatively influenced by the Neonatal Intensive Care Unit (NICU) environment and nursing practices. Identification of interventions that promote the development of parenting skills in the NICU can potentially improve developmental outcomes for premature infants. Summary of the Literature (4) This summary is based on searches of MEDLINE and CINAHL from 1975 to 1995. Search parameters included parentchild relations; parenting: infant, newborn; intensive care unitsneonatal; intensive care, neonatal; and parents. A description of research articles included in this summary can be found in Table 1. (5) In order to identify factors in the NICU experience that impact parents’ abilities to successfully parent their premature infants it is important to identify determinants of successful parenting in general, and also describe the characteristics of the premature infant and tasks of parenting that enter into the equation. With this information, the NICU experience can then be explored in context. Statement of the Practice Problem (2) The purpose of this paper is to identify aspects of the neonatal intensive care (NICU) experience that negatively impact upon the parents’ ability to successfully parent their infant after discharge. It has been identified that the NICU experience can lead to disturbances in parenting (Gennaro, 1991 [5]). Gennaro states, “These disturbances may be as minor as increased clumsiness and uncertainty in caretaking activities or as major as child abuse” (p.55 [5]). It is also known that the home environment and the level of parenting skills the family possesses contributes significantly to the eventual developmental outcome of the premature infant (Schraeder, Rappaport, & Courtwright, 1987 [18]). In some cases, the disturbances in parenting that occur due to the NICU experience may contribute to a poorer developmental outcome for the infant. Therefore, identification of factors that impact the parents’ abilities to successfully parent their premature infants can lead to interventions that minimize negative effects of the NICU experience, strengthen parenting skills, and improve the long-term outcome of the infant. (3) Low birth weight and premature delivery continue to be major problems in the United States. Ladden (1990 [9]) reported that in the United States, 7% of all infants were considered low birth weight (less than 2500 gm). Nineteen percent of these infants were rehospitalized in the first year of life, as opposed to 8% of normal birth weight infants. The costs to society, both economically in health care utilization dollars and socially in terms of lower functioning children, are significant. Tasks and Characteristics of Successful Parenting (6) Belsky (1984 [1]) describes three determinants of parental functioning. These include the parents’ personalities and psychological well-being, contextual subsystems of support, and the child’s temperament. Contextual subsystems of support encompass emotional support, advice and information, and the provision of social expectations (designation of what is and is not appropriate behavior). He stresses that “parenting that is sensitively attuned to children’s capabilities and to the developmental tasks they face promote a variety of highly valued developmental outcomes, including emotional security, behavioral independence, social competence, and intellectual achievement” (p.85 [1]). McCain (1990 [10]) identifies tasks that parents and infants must accomplish in order to achieve optimal developmental outcome of the infant. The infants’ tasks include demonstrating their needs through cues (crying, fussing, sleeping, eating, etc.) and responding to the parent (smiling, making eye contact, vocalizing, etc.). The parents’ tasks include recognizing the infant’s cues and responding to them appropriately. This implies a reciprocity between the parent and infant, where each gives feedback to the other. (7) Mintzer, Als, Tronick, and Brazelton (as cited in Yoos, 1989 [19]) identified that in preterm infants, reciprocity of feedback may not be present to the same extent as in interactions with full term infants. Preterm infants are less attentive and responsive than full term infants. They are more irritable, disorganized, difficult to feed, and their cues are harder to Volume 3 August 24, 1996 Document Number 7