背景:许多父母在早产儿出生后在新生儿重症监护病房(NICU)住院时会出现压力相关症状和抑郁症状。我们回顾了在单户家庭房(SFR)或开放式新生儿病房(OBU)住院的早产儿的父母健康状况的证据。
方法:对于本系统综述和荟萃分析,我们搜索了MEDLINE,EMBASE,PsycINFO,Cochrane中央对照试验登记册(中央),WebofScience,Clinicaltrials.gov,和国际临床试验注册平台(ICTRP)数据库从开始到2019年11月22日,使用与早产和NICU设计相关的受控术语和文本词。我们纳入了随机和非随机研究,比较了接受SFR或OBU的早产儿父母的结局。使用CochraneCollaboration的随机对照试验的偏倚风险工具和非随机干预研究的偏倚风险工具(ROBINS-I)评估方法学质量。结果包括:父母的压力,满意,参与(存在/参与/皮肤对皮肤护理),自我效能感,父母-婴儿结合,抑郁症,焦虑,创伤后应激,赋权,以及以家庭为中心的护理程度。使用具有标准化平均差(SMD)的随机效应模型计算汇总估计值。PROSPERO注册:CRD42016050643。
结果:我们确定了614种独特的出版物。11个研究人群(1,850名早产儿,包括1,549名母亲和379名父亲)。除一项研究外,所有研究都面临严重到严重的偏倚风险。SFR与更高水平的父母存在相关,参与,和皮肤对皮肤的护理。出院时,SFR与较低的压力水平相关(n=828父母,SMD-0·30,95CI-0·50;-0·09,p<0·004,I2=46%),特别是与NICU相关的应激(n=573,SMD-0·42,95CI-0·61;-0·23,p<0·0001,I2=0%)。在大多数研究中,更高水平的赋权,以家庭为中心的护理,对SFR感到满意。焦虑没有发现差异,父母与婴儿的联系,或者自我效能感。抑郁症很高(高达29%),但不同设置之间没有差异。没有研究描述创伤后应激。
结论:单身家庭间似乎有利于父母的存在,参与,皮肤对皮肤的护理,减少与NICU相关的父母压力。
BACKGROUND: Many parents develop stress-related symptoms and depression when their preterm infant is hospitalised in the neonatal intensive care unit (NICU) after birth. We reviewed the evidence of parent well-being with preterm infants hospitalised in single family rooms (SFRs) or in open bay neonatal units (OBUs).
METHODS: For this systematic review and meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP) databases from inception through 22 November 2019 using controlled terms and text words related to prematurity and NICU-design. We included randomised and non-randomised studies comparing outcomes in parents with preterm infants admitted to SFRs or OBUs. Methodological quality was assessed using Cochrane Collaboration\'s Risk of Bias Tool for randomised controlled trials and the Risk of Bias Tool for Non-Randomised Studies of Interventions (ROBINS-I). Outcomes included: parental stress, satisfaction, participation (presence/involvement/skin-to-skin care), self-efficacy, parent-infant-bonding, depression, anxiety, post-traumatic stress, empowerment, and degree of family-centred care. Summary estimates were calculated using random effects models with standardised mean differences (SMDs). PROSPERO registration: CRD42016050643.
RESULTS: We identified 614 unique publications. Eleven study populations (1, 850 preterm infants, 1, 549 mothers and 379 fathers) were included. All but one study were at serious to critical risk of bias. SFRs were associated with higher levels of parental presence, involvement, and skin-to-skin care. Upon discharge, SFRs were associated with lower stress levels (n = 828 parents, SMD-0·30,95%CI -0·50;-0·09, p<0·004, I2=46%), specifically NICU-related stress (n = 573, SMD-0·42,95%CI -0·61;-0·23, p<0·0001, I2=0%). In majority of studies higher levels of empowerment, family-centred care, and satisfaction was present with SFRs. No differences were found for anxiety, parent-infant bonding, or self-efficacy. Depression was high (up to 29%) but not different between settings. No studies described post-traumatic stress.
CONCLUSIONS: Single family rooms seem to facilitate parental presence, involvement, skin-to-skin care, and reduce NICU-related parental stress.