Reducing parental trauma and stress in neonatal intensive care: systematic review and meta-analysis of hospital interventions

Abstract

Objective: To classify NICU interventions for parental distress and quantify their effectiveness.

Study design: We systematically reviewed controlled studies published before 2017 measuring NICU parental distress, defined broad intervention categories, and used random-effects meta-analysis to quantify treatment effectiveness.

Results: Among 1643 unique records, 58 eligible trials predominantly studied mothers of preterm infants. Interventions tested in 22 randomized trials decreased parental distress (p < 0.001) and demonstrated improvement beyond 6 months (p < 0.005). In subgroup analyses, complementary/alternative medicine and family-centered instruction interventions each decreased distress symptoms (p < 0.01), with fathers and mothers improving to similar extents. Most psychotherapy studies decreased distress individually but did not qualify for meta-analysis as a group.

Conclusion: NICU interventions modestly reduced parental distress. We identified family-centered instruction as a target for implementation and complementary/alternative medicine as a target for further study. Investigators must develop psychosocial interventions that serve NICU parents at large, including fathers and parents of full-term infants.

Figure 1.

Study selection flow diagram.

Figure 2.

Forest plot of randomized studies. (SMD – standardized mean difference)

Figure 3.

Funnel plot of randomized studies. Three outlier effect sizes represent two studies by Behestipour et al and Mianaei et al that were excluded in post-hoc sensitivity analysis.