Managing Parents in

the NICU
Mohamed Khashaba
Professor of Pediatrics, Neonatology
Mansoura Faculty of Medicine
 The environment in which the child is

reared is the primary predictor of outcome

in school and his ability to integrate into

society.

Gross et al, 2001

 Admission of the Newborn to NICU is
usually unexpected and stressful for the
parents.
 There is usually no time to prepare the
family.
 Emotional Responses by Parents
 Shock
 Denial
 Grief
 Fear
 Sadness
 Anger
 Guilt
 Those parents are more prone to
clinical depression later on.

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 Cultural and religious variations cause

differences in reactions.
 Different responses by parents are not

necessarily abnormal.

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 Typical concerns
1. Infant appearance and health.
2. Course in the NICU.
3. Separation/ not feeling like a parent.
4. Disruption of family: family routines, time,
tasks and other siblings.
5. Difficulty with breast feeding.
6. Communication with medical staff.
7. Post discharge expectations.
8. NICU environment.
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Cairo, 22nd March 2007
 Additional stresses
 Maternal ill health.

 Sudden changes.

 Financial hardship.

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 Mother and Father reaction

1. They experience stresses differently in

intensity and time schedule.
2. They prioritize the concerns differently.

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 Mother tends to look support from others
and to search for an explanation.
 Father tends to minimize the situation
often by concentration on supporting his
partner.

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 Differences in stress and concerns
may be a source of severe family distress
and /or disruption.

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 Stresses after discharge

More dramatic for families of infants

with ongoing medical issues and home
care needs.

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 Stresses after discharge
1. Insecurity with their abilities.
2. Bonding and attachment issues.
3. Financial stress.
4. Isolation, reduced contact with family
and friends.
5. Restment felt by siblings.

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 Managing parent’s stresses

 A family oriented approach to care

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 Neonatal team meet the parents before
birth “ when time permits” to discuss any
likely admission.
 Parents may visit NICU before birth of the
baby.

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 An official welcome

 Tour in the NICU.

 Knowledge tought about the routines.

 Teach the mother how to touch and hold

the baby.
 Explain the technology.

 Short pamphlets and handouts.

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Cairo, 22nd March 2007
Cairo, 22nd March 2007
Cairo, 22nd March 2007
 Involvement of the parents in decision
making and care from the early stages.

 Involvement may extend from simple to

more complicated issues.

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 Practical Hints
Special areas should be included in NICUs for:
2. Counseling of parents.
3. Breast feeding of infants.
4. Support of grieving parents.

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 Practical Hints

 Rooms for parents in the hospital.

 Adjacent facilities outside the hospital.

 Reverse transportation.

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 Discharge Planning

1. Learning how to manage medicines

,tube feeding and other details.

2. Documentation of mother’s knowledge,

ability and confidence by a trained staff.

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 Examples of Training aspects

1. Preparation, dosing and storage of medicines.

2. Use of Oxygen and monitors.

3. Ability to provide adequate nutrition.

4. Recognize signs of illness and acute

deterioration.

5. Basic NCPR training.

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 Discharge plan time table

1. May start 1-2 weeks before discharge.

2. Rooming in for 1-2 nights before

discharge will help.

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 Summary Points
1. Having a NICU baby is stressful to parents.
2. Parents manage stress and anxiety in many
ways that are not consistent across different
families, religions and cultures.
3. Fathers and mothers differ in how they cope
with stress.
4. Appropriate support for parents should be an
integral part of neonatal care.
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Cairo, 22nd March 2007