A Proposed Investigation: The Impact of Neonatal Intensive Care Unit Infants
on Parental and Family Outcomes
Victoria A.
1
1
Grunberg ,
Drexel University; 2 Drexel University College of Medicine
Introduction
The birth of a child is an exciting and challenging time for parents.
The first few years following birth involve an adjustment period as
parents work together to balance work, family, infant care, and selfcare. Approximately 7 - 15% of parents will have an infant that will
spend some amount of time in a Neonatal Intensive Care Unit
(NICU). These parents experience the typical stressors associated
with parenthood plus the additional stress of worrying about their
infant’s survival, development, and/or long-term health. After NICU
discharge, parents are sent home to care for an ill and/or preterm
infant and often continue to worry about rehospitalizations, ongoing
health issues, and the long-term impact of the experience. Parents
continue to experience distress during the first few years following
discharge because the care for these infants can be difficult and
strenuous (Howe et al., 2014). The impact of the NICU experience
and subsequent infant health issues on parental and family outcomes
is an understudied area that merits research attention.
Pamela A. Geller,
1,2
PhD
Hypotheses
(1)  Parental report of infant past and current health will be
associated with parental stress levels and perceptions of
marital and family impact.
a)  More severe infant illness/condition at the time of NICU
admission will be associated with:
a)  More parental stress,
b)  More perceived stress,
c)  Greater impact on family, and
d)  Poorer marital functioning.
b)  More severe infant current illness/condition will be
associated with:
a)  More parental stress,
b)  More perceived stress,
c)  Greater impact on family, and
d)  Poorer marital functioning.
(2)  The relationship between infant health, parental stress,
marital and family impact will be moderated by:
a)  Family resources, such that greater family resources will
attenuate the resulting stress.
Methods
Measures
• Socio-Demographics Questionnaire (e.g., gender, age, race/
ethnicity, psychological history, reproductive history)
• Infant Past and Current Health (e.g., birth weight, length of time in
NICU, days on ventilator, diagnoses, rehospitalizations)
• Parental Stress Index – Short Form (PSI – SF; Abidin, 1995)
• Perceived Stress Scale – 10 (PSS – 10; Cohen & Williamson, 1988)
• Impact on Family Scale Revised (IOF – F; Stein & Jessop, 2003)
• Revised Dyadic Adjustment Scale (RDAS; Busby, Christensen,
Crane, & Larson, 1995)
• Family Resource Scale, Revised (FRS – R; Van Horn, Bellis, &
Synder, 2001)
Statistical Plan
• Multivariate regression analyses will be used to examine infant
health, parental stress, marital and family impact.
• Moderation analyses will be used to examine how family resources
and other demographic variables influence that relationship.
• Gender differences will also be examined using regression analyses
(3)  Men and women will differ in the strength of the
hypothesized associations.
Methods
Participants
The Current Study
The current study will examine how the NICU experience and
subsequent infant health problems that may follow during the first few
years after discharge effects parental stress, and marital and family
dynamics. A variable known to attenuate stress and family outcomes
(i.e., family resources) will also be examined. Parents whose child
has been discharged from the NICU 6 months to 3 years ago will be
recruited via the Internet. Parents will self-report their infant’s past
and current health, parenting stress, perceived stress levels, family
impact, access to family resources, and marital functioning. Parents
of both genders will be invited to participate in order to gain a more
comprehensive picture of perspectives and experiences, and to
compare responses of mothers and fathers.
Biological mothers of infants who were admitted to a NICU 6 months to
3 years ago and their partners’ or spouses’ who are currently in an
intimate relationship with each other and cohabitating together and with
the infant since NICU discharge will be eligible to participate.
Participants must be at least 18 years old at the time of entry into the
study and reside in the United States. The infant must currently be alive
and must have been born a singleton.
Recruitment
Participants for the current study will be recruited using the Internet.
The study will be advertised on websites aimed towards supporting
NICU parents. Online support communities/forums, blogs, and social
networking websites (e.g., Facebook, Twitter, Pinterest, Craigslist,
YouTube) with information related to NICU parenting will be contacted
with a request to advertise about the study and to post a link to the
Qualtrics survey. NICU follow-up clinics and pediatrician offices will be
contacted to post and distribute flyers containing information about the
study to their patients.
Clinical Implications
This study is among the first to explicitly assess the impact that NICU
admission and current child’s health has on the marriage, family and
parental stress within the first few years after the child’s birth. Past
researchers focused on maternal responses to NICU admissions,
usually among preterm versus full term infants and excluding other
medical diagnoses (Gray et al., 2012; Howe, Sheu, Wang, & Hsu,
2014); the current study will include families who are coping with a
variety of medical diagnoses. This study will include both mother and
father/partner responses in order to understand differences and
similarities in their perceptions of stress, marital and family impact. In
addition to advancing knowledge in this field, the results could have
meaningful clinical implications. The parental relationship and family
dynamic greatly impact outcomes for the child’s development
(Huhtala, Korja, Lehtonen, Haataja, Lapinleimu, & Rautava, 2012).
Findings could inform researchers, families, and health care providers
about parental responses to NICU admission and how to best handle
subsequent health problems, thereby informing interventions on the
best way to improve psychological outcomes for parents and families.
Please see author for reference list.
Contact: Victoria Grunberg at vag47@drexel.edu