Maternal Stress and Depressive Symptoms Associated with Quality of Developmental Care in 25 Italian Neonatal Intensive Care Units: a Cross Sectional Observational Study

Background: Parents of very preterm infants are at great risk for experiencing stress and depression. The so called developmental care oriented approach used in Neonatal Intensive Care Units have beneficial effects for parents. However the actual level of developmental care may vary among units and little is known about how the routine adoption of developmental care affects maternal stress and depression.

Objectives: To investigate the extent to which level of quality of developmental care routinely carried out in 25 tertiary Neonatal Intensive Care Units across Italy affects maternal stress and depression.

Participants: 178 mothers of healthy very preterm infants with gestational age ≤29wk and/or birth weight ≤1500g and without documented neurologic pathologies were recruited consecutively. 180 full-term mothers were recruited as the control group.

Methods: To distinguish the quality of developmental care level, each unit was assessed using a specifically developed questionnaire. We compared negative emotional states of mothers by splitting the 25 Neonatal Intensive Care Units into units with high-care and low-care based on median splits for two main care factors: (1) The Infant Centered Care index (consisting of measures of parent involvement, including ability to room in, frequency and duration of kangaroo care and nursing interventions aimed at decreasing infant energy expenditure and promoting autonomic stability). (2) The Infant Pain Management index (consisting of measures to decrease painful experiences including pharmacologic and nursing care practices). Maternal stress was assessed by the Parental Stressor Scale: Neonatal Intensive Care Unit questionnaire. Maternal depressive symptomatology was assessed by the Edinburgh Postnatal Depression Scale questionnaire.

Results: Preterm mothers from low-care units in the Infant Pain Management reported higher scores in their perception of stress associated with behavior and appearance of the infant than mothers from high-care units (p=0.05). Preterm mothers from high-care units in the Infant Pain Management reported a depressive symptomatology score average similar to that reported by full-term mothers. No significant Infant Centered Care effect was found both for maternal stress and depression.

Conclusions: The findings suggest that implementing more practices useful to reduce infants' painful experience can mitigate the stress and depressive symptomatology of the preterm mothers.