Helping Parents To Care for Premature Babies in the NICU

article

Helping Parents Care for a Newly Born Premature Baby in the NICU

9 minutes

09/09/2020

Spending time in a neonatal intensive care unit (NICU) can be a daunting experience for parents of premature babies, not only because of their newborn’s prematurity and associated medical complications, but because the NICU is an unfamiliar and complex environment. Today, parents have a greater opportunity to be more hands-on with their premature babies in the NICU as more hospitals are widely adopting family-centred care. Family-centred care, promotes a cooperative relationship between parents and healthcare providers in all aspects of a preterm infant’s care, continues to evolve ensuring the whole family becomes more integrated into the delivery of care to NICU patients.1

The important role of parents in the NICU

As part of the UNICEF Baby Friendly Initiative’s guidance to neonatal units, managing parents’ experience of care is cited as a key foundation in ensuring the optimal care and recovery of NICU patients2.

By enabling parents of preterm babies in the NICU to participate in the care of their child, they will know how to care for the infant following discharge from the hospital3, with the added important benefit of strengthening their emotional bond with the infant4,5. Touch is a critical component of strengthening this bond3 and there are multiple ways parents can be more involved in the day-to-day care of their newborn in the NICU.

According to leading neonatal charities throughout the world dedicated to the care of critically ill and premature babies, parents can be involved in the daily care of their premature infants with the support of nurses, particularly when it comes to6:

  • Bathing

  • Changing nappies

  • Kangaroo mother care

  • Holding and comforting baby

  • Providing breastmilk

A newly born premature baby being held by it’s mother

Bathing

Parents of premature babies can be tentative about handling their newborn. Nurses play a vital role in educating parents about the delicate nature of a premature infant’s skin to empower them to be involved in their baby’s daily care. Sponge bathing is usually deemed the safest and most beneficial form of cleaning a premature infant7.

Fast facts for parents about premature babies’ skin

  • Premature infants are skinnier and have less body fat8

  • The skin of a premature baby can be extremely red but is actually translucent as it is not yet fully developed9

  • A premature baby’s skin is very thin, sensitive and prone to irritation, especially nappy rash6,7,8

Changing nappies

Cleaning the nappy area is important in order to protect a premature baby’s delicate skin. Whilst hospitals will usually have their own preferred methods, parents often seek guidance for a commercial wipe following hospital discharge. A review published in Paediatric Dermatology6 found that wipes containing ingredients such as glycerin and citric acid can be harmful to the pH of a premature infant’s skin compared to cloth and water. A wipe with minimal ingredients, such as WaterWipes which contains 99.9% purified water and a drop of fruit extract, helps maintain the important skin barrier function of the stratum corneum. WaterWipes are the preferred wipe for many NICUs throughout Australia and New Zealand and around the world.

Kangaroo mother care

Kangaroo care, often used interchangeably with skin-to-skin contact (SSC), is a long-established practice in hospitals and NICU worldwide. Provided SSC is safely administered10, it has been associated with improving newborn physiologic stability, promoting breastfeeding and healthy growth and development.11,12,13,14

Benefits to Baby

  • Maintain baby’s body temperature

  • Regulates baby’s heart and breathing rates

  • Encourages baby to spend more time in a deep sleep

  • Increases baby’s weight gain

  • Improved oxygen saturation levels

  • Can improve breast milk production and increases the chances of successful breastfeeding

  • Longer periods of alertness

  • Helps promote frequent breastfeeding

Benefits to parents

  • Building parental confidence

  • Increasing their bond with baby and can ease feelings of separation, positively impacting the mental wellbeing of the parents

  • Improving breast milk production and increasing the chances of successful breastfeeding

Fathers and skin-to-skin contact

Fathers can also benefit from SCC15 with reduced spousal relationship problems16; strengthening of their paternal role16, and helping them transition into a more equal parenthood.20

The power of SSC

To demonstrate the true power of SSC between parents and newborns, WaterWipes teamed up with one of the world’s leading experts on kangaroo care, Dr. Susan Ludington to track the impact of SSC on three newborns. Check out the powerful videos to see how SSC regulated their baby’s breathing, heart rate, oxygen levels and temperature within five minutes of being held in this position.

Holding and comforting baby

SSC may not be appropriate for certain premature infants, but parents should not be discouraged as their touch can be just as powerful. Parents may not realise but a simple touch can17:

  • Calm baby during uncomfortable or painful procedures

  • Soothe a restless baby

  • Encourage baby to be quietly awake and responsive

This can take many forms, such as simply holding baby for shorter periods of time, swaddling, encouraging suckling, massage or simply lying close to the baby’s incubator21,18,19,20. Encourage parents to explore ways they can physically engage with their babies in the NICU as every baby is unique and will respond differently.

A parent holding a premature baby’s’ foot

Did you know?

The skin is the largest sense organ, and the first to develop, even within the womb, so all newborns are wired to respond to touch.24 A newborn continuously receives stimulation through being breastfed and cuddled, which is vital for both growth and development.24,21

Did you know?

Parents of premature babies are 2.5 times more likely to suffer postnatal depression. and one in five parents who have had an extremely preterm birth (before 30 weeks) still show symptoms of depression and anxiety six months postpartum.

It isn’t just mothers that are affected, fathers to very premature babies are also at increased risk with one third experiencing high rates of depression and half suffering elevated anxiety levels..27,28,29

Maternal skin-to-skin contact in the NICU can have a positive impact on the mother too, including improved mood, a decrease in stress and postpartum depression, in addition to stimulating a care-giving environment.22,23,24

Summary

Enabling parents to take an active role in their baby’s care significantly improves their experience in the NICU.

It is important to remember, parents know their baby better than anyone. Advocating the important role of parents in the NICU is crucial not only for the baby’s development but to empower parents as the baby’s primary caregivers. This is especially important as baby transitions toward home. Parents who are actively involved in the care of their baby in the NICU will see a positive impact on their baby and also their own mental health and parent-child bonding.

Lucille Bradfield, Clinical Nurse Manager Neonatal

WaterWipes is proud to support NICUs and premature baby organisations around the world including Miracle Babies Foundation (Australia).

Accessing support for families

Miracle Babies NurtureLine: 1300 MBABIES or 1300 622 243

In Australia, families to a premature or sick newborn can access emotional support through organisations such as Miracle Babies Foundation. The Miracle Babies 24 Hour Family Support Line (NurtureLine) provides access to a trained support team and can assist parents and extended family members in coping with the experience of having a baby remain under the care of the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN), and beyond after discharge.

Face-to Face Support in hospital

Whilst babies remain in hospital, face-to-face support services also run in many NICUs and Special Care Nurseries nationally (NurtureTime). During these services, Miracle Babies Foundation Support Teams visit the units to provide much needed support to these families. Families can check www.miraclebabies.org.au to see whether this service is available at their hospital.

Miracle Babies Foundation also provides tools, resources and information to families. Distributed to them via the hospital (participating hospitals).

Useful resources

In addition to the leaflets for parents your hospital may already provide, below are some useful resources for you to help educate and empower parents in their care of their premature baby:

Unicef: You and your baby: Supporting love and nurture on the neonatal unit

Bliss: Resources for parents

Tommys: Your premature baby's time in hospital

References
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1Banerjee J, Aloysius A, Platonos, K. & Deierl, A.. (2017). Family centred care and family delivered care – What are we talking about? Journal of Neonatal Nursing. 24. 10.1016/j.jnn.2017.11.004.

2UNICEF UK (2018) Baby Friendly Initiative: Guidance for Neonatal Units, https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2015/12/Guidance-for-neonatal-units.pdf [accessed April 2020]

3European Foundation for the Care of Newborn Infants (date unknown). The family in the NICU https://www.efcni.org/health-topics/in-hospital/developmental-care/the-family-in-the-nicu/ [accessed April 2020]

4Flacking R, Lehtonen L, Thomson G, et al. Closeness and separation in neonatal intensive care. Acta Paediatr. 2012;101(10):1032‐1037. doi:10.1111/j.1651-2227.2012.02787.x

5Bry A, Wigert H. Psychosocial support for parents of extremely preterm infants in neonatal intensive care: a qualitative interview study. BMC Psychol. 2019;7(1):76. Published 2019 Nov 29. doi:10.1186/s40359-019-0354-4

6 Bliss (date unknown) Getting Involved info card https://shop.bliss.org.uk/shop/files/19022FCCinfocardfinallowres.pdf [accessed April 2020]

7Kusari, A, Han, AM, Virgen, CA, et al (2019). Evidence‐based skin care in preterm infants. Pediatr Dermatol. 2019; 36: 16‐ 23. https://doi.org/10.1111/pde.13725

8American Academy of Pediatrics (2015) Caring For A Premature Baby, adapted from Caring for Your Baby and Young Child: Birth to Age 5, 6th Edition https://www.healthychildren.org/English/ages-stages/baby/preemie/Pages/Caring-For-A-Premature-Baby.aspx [accessed April 2020]

9Cherney, K. (2016) Skin Problems in the Premature Baby, Healthline https://www.healthline.com/health/pregnancy/premature-baby-skin-problems [accessed April 2020]

10Mori, R., Khanna, R., Pledge, D. and Nakayama, T. (2010), Meta‐analysis of physiological effects of skin‐to‐skin contact for newborns and mothers. Pediatrics International, 52: 161-170. doi:10.1111/j.1442-200X.2009.02909.x

11Johnston CC, Campbell-Yeo M, Filion F. Paternal vs Maternal Kangaroo Care for Procedural Pain in Preterm Neonates: A Randomized Crossover Trial. Arch Pediatr Adolesc Med. 2011;165(9):792–796. doi:https://doi.org/10.1001/archpediatrics.2011.130

12Pados, B (2018). Physiology of Stress and Use of Skin-to-Skin Care as a Stress-Reducing Intervention in the NICU. Nursing for Women's Health. 23. 10.1016/j.nwh.2018.11.002.

13Mekonnen AG, Yehualashet SS, Bayleyegn AD. The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and LBW infants: a meta-analysis of published studies. Int Breastfeed J. 2019;14:12. Published 2019 Feb 19. doi:10.1186/s13006-019-0206-0

14Phillips RM, Goldstein M, Hougland K, et al. Multidisciplinary guidelines for the care of late preterm infants. J Perinatol. 2013;33 Suppl 2(Suppl 2):S5‐S22. doi:10.1038/jp.2013.53

15Srinath B, Shah J, Kumar P & Shah P. (2015). Kangaroo care by fathers and mothers: comparison of physiological and stress responses in preterm infants. Journal of Perinatology: official journal of the California Perinatal Association. 36. 10.1038/jp.2015.196.

16Blomqvist, Y.T., Rubertsson, C., Kylberg, E., Jöreskog, K. and Nyqvist, K.H. (2012), Kangaroo Mother Care helps fathers of preterm infants gain confidence in the paternal role. Journal of Advanced Nursing, 68: 1988-1996. doi:10.1111/j.1365-2648.2011.05886.x

17Bliss (date unknown) Skin-to-skin and Kangaroo Care, https://www.bliss.org.uk/parents/in-hospital/looking-after-your-baby-on-the-neonatal-unit/skin-to-skin-and-kangaroo-care [accessed April 2020]

18March of Dimes (2017) Touching and holding your baby in the NICU https://www.marchofdimes.org/complications/touching-and-holding-your-baby-in-the-nicu.aspx [accessed April 2020]

19Tommy’s (date unknown) Caring for your baby: your role https://www.tommys.org/pregnancy-information/pregnancy-complications/premature-birth/your-babys-time-hospital/caring-your-baby-your-role [accessed April 2020]

20Field, T. (2010). Touch for socioemotional and physical well-being: A review. Developmental Review, 30(4), 367-383. https://doi.org/10.1016/j.dr.2011.01.001

21Feldman, R., Singer, M. and Zagoory, O. (2010), Touch attenuates infants’ physiological reactivity to stress. Developmental Science, 13: 271-278. doi:10.1111/j.1467-7687.2009.00890.x

27 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922346/

28 Pace CC, Spittle AJ, Molesworth CM, et al. Evolution of Depression and Anxiety Symptoms in Parents of very preterm Infants During the Newborn Period. JAMA Pediatr. 2016;170(9):863–870.doi:10.1001/jamapediatrics.2016.0810

29 https://www.mcri.edu.au/news/alarming-rates-depression-parents-babies-born-30-weeks

22Angelhoff C, Blomqvist YT, Sahlén Helmer C, et al. Effect of skin-to-skin contact on parents' sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial. BMJ Open. 2018;8(7):e021606. Published 2018 Aug 1. doi:10.1136/bmjopen-2018-021606

23Baley J. (2015). Skin-to-Skin Care for Term and Preterm Infants in the Neonatal ICU. Pediatrics. 136. 10.1542/peds.2015-2335.

Cowan, H & Lilley T (2013) Supporting skin-to-skin care in the neonatal unit. Infant 2013; 9(3): 89-91.


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