PARENTAL ANXIETY AND MEDICAL COMPREHENSION WITHIN 24 HOURS OF A CHILD'S ADMISSION TO THE PEDIATRIC INTENSIVE CARE UNIT

Needle JS, O'Riordan M, Smith PG. Pediatr Crit Care Med. 2009;10(6):668-673.

This prospective cohort study with a convenience sample of primary caregivers of critically ill children examined factors that contribute to parental anxiety and the effect that parental anxiety has on comprehension of medical information within 24 hours of a child's admission to the pediatric intensive care unit. Physician recognition of parental anxiety related to their child's hospitalization was also evaluated.

Thirty-four parents completed the State-Trait Anxiety Inventory. Of these, 21 (62%) had state anxiety that was significantly higher than a validated sample of patients with generalized anxiety disorder. If the child required mechanical ventilation, this proved to be a significant predictor of high parental state anxiety. Twenty-eight parents completed a questionnaire of comprehension, with 26 (93%) demonstrating excellent or fair comprehension. Physicians generally had a low recognition of parental anxiety but were more likely to rate a parent's anxiety as high if the child was on mechanical ventilation.

The researchers conclude with an expected but interesting finding that, despite high anxiety, parental comprehension of a child's illness following pediatric intensive care unit admission was good, but also recommend further research to improve physician assessment of parental anxiety.

THE STOCKHOLM NEONATAL FAMILY-CENTERED CARE STUDY: EFFECTS ON LENGTH OF STAY AND INFANT MORBIDITY

Ortenstrand A, Westrup B, Brostrom E, et al. Pediatrics. 2010;125(2):e278-e285.

This randomized controlled trial was conducted in two level 2 neonatal intensive care units (NICUs), with both having a standard care and a family care ward-where parents could stay from infant admission to discharge to evaluate and compare the length of stay and infant morbidity. Family care is a new model, and parents can stay 24 hours a day.

Three hundred sixty-six infants born before 37 weeks' gestation were randomly assigned to standard care and family care. The researchers found a reduction of 5 days' total hospital stay in preterm neonate admitted to a level 2 NICU where parents could stay compared with standard NICU care. The authors further state that parents who spend most of their time with their newborn may have a greater opportunity to interpret and act on signs of distress and other needs of their infant compared with what is possible for the NICU staff who may have more than 1 infant to care for. There was no statistical difference noted in infant morbidity, except for a reduced risk of moderate to severe bronchopulmonary dysplasia.

Researchers conclude that providing facilities for parents to stay in the neonatal unit from admission to discharge may reduce the total length of stay for infants born prematurely. The reduced risk of moderate to severe bronchopulmonary dysplasia needs further investigation.