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Neonatal Intensive Care

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Clinical Handbook of Psychological Consultation in Pediatric Medical Settings

Part of the book series: Issues in Clinical Child Psychology ((ICCP))

Abstract

Psychology consultation to the neonatal intensive care unit (NICU) is relatively new. However, with growing recognition that both the infant and each part of the vulnerable infant’s support system can be adversely impacted by the NICU course, psychologists are increasingly being called upon to consult to the NICU. Consultation in the NICU requires a diverse skill set for psychologists, including understanding issues related to perinatal functioning, infertility, bereavement, transition to parenting, infant mental health including the parent-infant attachment processes, adult mental health, co-parenting, family systems, and neurodevelopmental functioning of at-risk infants. With more medically complex infants surviving than ever before, families are enduring lengthy infant hospitalizations and being exposed to a greater number of traumatic events. Without intervention, parental distress can persist, and infant development may be further compromised. Psychologists can aid in implementing recent recommendations for screening for parental distress, as well as conducting comprehensive assessments and providing interventions in the NICU setting. Although rigorous empirical studies of NICU-based interventions are limited, psychologists can offer a variety of intervention approaches with promising outcomes. In addition to the impact on infants and families, higher medical acuity in the NICU results in more challenges for the NICU multi-disciplinary team as they strive to provide family-centered care. Therefore, consulting psychologists also have a role in supporting and educating staff, toward the end goal of supporting both staff functioning as well as indirectly supporting families.

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Author information

Authors and Affiliations

  1. The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Casey Hoffman

  2. Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Casey Hoffman

  3. Rush University Children’s Hospital, Chicago, IL, USA

    Michelle M. Greene

  4. Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA

    Michelle M. Greene

  5. Nationwide Children’s Hospital, Columbus, OH, USA

    Amy E. Baughcum

  6. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

    Amy E. Baughcum

Authors
  1. Casey Hoffman
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  2. Michelle M. Greene
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  3. Amy E. Baughcum
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Corresponding author

Correspondence to Casey Hoffman .

Editor information

Editors and Affiliations

  1. Pediatric Consultation-Liaison Service, Norton Children’s Hospital, Louisville, KY, USA

    Bryan D. Carter

  2. Department of Pediatrics, University of Louisville, School of Medicine, Louisville, KY, USA

    Bryan D. Carter

  3. Department of Pediatrics, C.S. Mott Children’s Hospital Michigan Medicine, Ann Arbor, MI, USA

    Kristin A. Kullgren

Appendices

Appendix 1: Mental Health Screening Instruments Commonly Used for Parents of Infants

Screening tool

Domain assessed

Number of items

Public domain

Notes

Edinburgh Postpartum Depression Scale (EPDS)a

Postpartum depression

10

Yes

Available in several languages, contains suicidal ideation question

Postpartum Depression Screening Scale (PDSS)b

Postpartum depression

35

No

Contains suicidal ideation question, has total score and seven subscores

Public Health Questionnaire (PHQ-2, PHQ-9)c

Depression in the general population

2, 9

Yes

PHQ-2 uses the first two items of the PHQ-9. Lower specificity than others, available in several languages

Center for Epidemiological Studies Depression Scale (CES-D)d

Depression in the general population

20

Yes

Original does not have suicidal ideation question, revised version does

Columbia Suicide Severity Rating Scale (C-SSRS) lifetime/recente

Suicide risk assessment

2–6, structured interview

Yes

Spanish versions available. Full-scale version also available for those who are trained

Impact of Events Scale—Revised (IES-R)f

Post-traumatic stress

22

Yes

Four symptom clusters

Davidson Trauma Scaleg

Post-traumatic stress

17

No

Three symptom clusters

PTSD checklist for DSM-V (PCL-5)h

Post-traumatic stress

20

Yes

Items map onto DSM-V diagnostic criteria

Modified Perinatal Post-Traumatic Stress Disorder Questionnaire (Modified PPQ)

Perinatal specific post-traumatic stress

14

Yes

Maps onto three symptom clusters

  1. ahttps://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/practicing-safety/Documents/Postnatal%20Depression%20Scale.pdf
  2. b https://www.wpspublish.com/store/p/2902/pdss-postpartum-depression-screening-scale
  3. chttps://www.phqscreeners.com/
  4. dhttp://www.chcr.brown.edu/pcoc/cesdscale.pdf;http://cesd-r.com/
  5. e http://cssrs.columbia.edu/the-columbia-scale-c-ssrs/about-the-scale/
  6. fhttp://www.emdrhap.org/content/wp-content/uploads/2014/07/VIII E_Impact_of_Events_Scale_Revised.pdf
  7. g https://www.mhs.com/MHS-Assessment?prodname=dts
  8. hhttps://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp
  9. i(Callahan, Borja, & Hynan, 2006)

Appendix 2: Sample of Neurobehavioral and Developmental Assessment Measures for NICU Infants

Measure

Age range

Domains assessed

NICU Network Neurobehavioral Scale (NNNs)a

28–46-week gestational age

Neurological integrity

Behavioral functioning

Stress/abstinence

Neurobehavioral Assessment of the Preterm Infant (NAPI)b

32–40-week gestational age

Motor development

Alertness and orientation

Irritability

Assessment of Preterm Infants’ Behavior (APIB)c

Birth–44-week gestation age

Autonomic

Motor

State organization

Attention

Self-regulation

Bayley Scales of Infant Development, Fourth editiond

1–42 months

Cognition

Language (receptive and expressive)

Motor (fine and gross)

Social-emotional

Adaptive

Mullen scales of early Learningd

1–68 months

Visual reception

Fine motor

Gross motor

Receptive language

Expressive language

  1. ahttps://www.brown.edu/research/projects/children-at-risk/about
  2. b http://med.stanford.edu/NAPI/methods.html
  3. c https://nidcap.org/en/programs-and-certifications/apib-training/overview-3/
  4. d https://www.pearsonassessments.com

Appendix 3: Suggested Resources for Psychologists Working with Families in the NICU

Source

Description

http://support4NICUparents.org

National Perinatal Association

Clinician resources for working in the NICU (see “for professionals” section)

http://postpartum.net

Postpartum support international

Provides resources and training for clinicians in perinatal mood and anxiety disorders

https://www.zerotothree.org

Zero to three

Resources and training for professionals working with young children

Handbook of Infant Mental Health, 4th Edition, by Charles H Zeanah Jr. (2019)

Definitive text on the impact of early influences on young child mental health, including information about assessment, interventions, and systems

Neurodevelopmental Outcomes of Preterm Birth by Chiara Nosarti, Robin Murray, and Maureen Hack (2010)

Summarizes the literature on the impact of prematurity on children from infancy to adulthood

Cognitive Behavioral Therapy for Perinatal Distress by Amy Wenzel and Karen Kleiman (2014)

Provides clinicians with guidance on the use of CBT for emotional distress in the prenatal and postpartum periods

Trauma Informed Care in the Perinatal Period by Julia Seng and Julie Taylor (2015)

Provides guidance on infusing trauma-informed care into perinatal work

Appendix 4: Suggested Resources for Families in the NICU

Source

Description

http://marchofdimes.org

March of Dimes

Resources and support for NICU families

http://support4NICUparents.org

National Perinatal Association

Resources and tools for NICU parents (see “For Parents” section)

http://postpartum.net

Postpartum Support International

Resources for parents about perinatal mood and anxiety disorders

http://www.p2pusa.org/

Parent to Parent USA

Emotional support and information for families of children with special health needs through creating a match with an experienced mentor parent

http://www.unitegriefsupport.org/

Unite Inc.

Grief support for miscarriage, stillbirth, and infant death

Understanding the NICU: What Parents of Preemies and other Hospitalized Newborns Need to Know by The American Academy of Pediatrics, edited by Jeanette Zaichkin, Gary Weiner, and David Loren (2016)

Comprehensive text to help families understand NICU medical terms and technology, major medical conditions and complications, and impact on parenting of having a hospitalized infant

NICU Journal: A Parent’s Journey by the American Academy of Pediatrics (2017)

Practical parent education about hospitalized infants with places to record week-to-week milestones and progress

Preemies: The Essential Guide for Parents of Premature Babies, 2nd Edition, by Dana Wechsler Linden, Emma Trenti Paroli, and Mia Wechsler Doron (2010)

Information provided by parents and a neonatologist about prematurity, from risks for prematurity through considerations for discharge

Parenting Your Premature Baby and Child: The Emotional Journey by Deborah L. Davis and Mara Tesler Stein (2004)

Focuses on the range of emotional reactions that parents experience when dealing with their child’s premature birth from prior to delivery through life after discharge, and provides considerations for ways to cope along the way

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Hoffman, C., Greene, M.M., Baughcum, A.E. (2020). Neonatal Intensive Care. In: Carter, B.D., Kullgren, K.A. (eds) Clinical Handbook of Psychological Consultation in Pediatric Medical Settings. Issues in Clinical Child Psychology. Springer, Cham. https://doi.org/10.1007/978-3-030-35598-2_22

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