Parent stress in neonatal intensive care unit: an unattended aspect in medical care

Ruma Agrawal, Ajay Gaur


Background: The birth of an infant that needs care in a neonatal intensive care unit (NICU) can be stressful for the parents. The parent-infant bonding process that occurs during the newborn period establishes the foundation for a lifelong relationship. This typical process does not occur when the infant spends the first several weeks or months in the NICU. Quantifying stress levels of parents and identifying the greatest environmental stressor by understanding the aspects of infants, parents and the environment that can cause stress may be useful in assisting the health personnel in understanding their importance and in improving the quality of care. The objective of the study was to quantify stress levels of parents of babies admitted in NICU and compare the sources of stress for mothers and fathers.

Methods: This was a cross-sectional, observational, hospital based study where stress levels were assessed using Parental Stressor Scale: neonatal intensive care unit (PSS: NICU) questionnaire among parents of 400 newborn admitted in NICU. Stress was quantified using 5 point Likert scale from 1 (not at all stressful) to 5 (extremely stressful). The overall stress levels were calculated for each subscale and total scale and compared.

Results: NICU environment is moderately stressful for both mother and father. The highest score was in the field of Relationship with the baby and parental role for mothers as well as for fathers. Mothers had significantly higher stress scores for each subscale and the total scale compared to fathers.

Conclusions: NICU parents are under significant stress and this is need of time to give family centered care. 


NICU, Newborn, NICU, PSS, Parents, Stress

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Case-Smith, J. Family-centered care in the neonatal intensive care unit. In E. Vergara (Ed.), Foundations for practice in the neonatal intensive care unit and early intervention: a self-guided practice manual. 1993;2:241-6.

Miles MS, Funk SG, Kasper MA. The stress response of mothers and fathers preterm infants. Res Nurs Health. 1992;15(4):261-9.

Holditch-Davis D, Miles MS. Mothers’ stories about their experiences in the neonatal intensive care unit. Neonatal Netw. 2000;19:13-21.

Klaus MH, Kennell JH. Mothers separated from their newborn infants. Paediatr Clin North America. 1970;17;1015-37.

Bregman J, Kimberlin LVS. Developmental outcome in extremely premature infants. Pediatr Clin North America. 1993;40:937-53.

Theunissen NCM, Veen S, Fekkes M, Koopman HM, Zwinderman KAH, Brugman E, et al. Quality of life in preschool children born preterm. Develop Med Child Neurol. 2001;43:460-5.

Sameroff AJ, Chandler MJ. Reproductive risk and the continuum of caretaking casualty. Review of child development research Chicago: University of Chicago Press. 1964;4:187-244.

Miles MS, Funk SG, Kasper MA. The neonatal intensive care unit environment: sources of stress for parents. AACN Clinical Issues in Critical Nursing. 1991;2(2):346-54.

Miles MS, Funk SG, Carlson J. Parental stressor scale: neonatal intensive care unit. Nurs Res. 1993;42:148-52.

Shields-Poe D, Pinelli J. Variables associated with parental stress in neonatal intensive care units. Neonatal Network. 1997;16(1):29-37.

Perehudoff B. Parents’ perceptions of environmental stressors in the special care nursery. Neonatal Network. 1990;9(2):39-44.

Dudek-Shriber L. Parent stress in the neonatal intensive care unit and the influence of parent and infant characteristics. Am J Occup Ther. 2004;58:509-20.

Chourasia N, Surianarayanan P, Adhisivam B, Vishnu Bhat B. Nicu admissions and maternal stress levels. Indian J Pediatr. 2013;80(5):380-4.

Singer LT, Salvator A, Guo S, Collin M, Lilien L, Baley J. Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA. 1999;281:799-805.

Dutta S, Mahajan R, Agrawal SK, Nehra R, Narang A. Stress in fathers of premature newborns admitted in a neonatal intensive care unit. Indian Pediatr. 2016;53(4):311-3.

Case-Smith J. Medical complications of preterm and high-risk infants. In J Case- Smith (Ed.), Occupational therapy for children. 2001;4:693-703.

Schraeder BD, Heverly MA, O’Brien C, Goodman R. Academic-achievement and educational resource use of very low birth weight (VLBW) survivors. Paediatr Nurs. 1997;23:21-5.

McCormick MC, Brooks-Gunn J, Workman-Daniels K, Turner J, Peckham GJ. The health and developmental status of very low-birth-weight children at school age. JAMA. 1992;267:2204-8.

McCormick MC, Workman-Daniels K, Brooks-Gunn J. The behavioural and emotional well-being of school-age children with different birth weights. Pediatr. 1996;97:18-25.

Klein NK, Hack M, Breslau N. Children who were very low birth weight: developmental and academic achievement at nine years of age. J Dev Behav Pediatr. 1989;10:32-7.

Saigal S, Szatmari P, Rosenbaum P, campbell D, King S. Cognitive abilities and school performance of extremely low birth weight children and matched term controls at age 8 years: a regional study. J Pediatr. 1991;118:751-60.

Miles MS, Carter MC, Riddle I, Hennessey J, Eberly TW. The paediatric intensive care unit environment as a source of stress for parents. Maternal-Child Nurs J. 1989;18(3):199-206.

Affonso DD, Hurst I, Mayberry LJ, Yost K, Lynch ME. Stressors reported by mothers of hospitalized premature infants. Neonatal Network. 1992;11(6):63-70.

Tommiska V, Ostberg M, Fellman V. Parental stress in families of 2 year old extremely low birth weight infants. Arch Dis Child Fetal Neonatal. 2002;86:161-4.

Jeffcoate JA, Humphrey ME, Lloyd JK. Role perception and response to stress in fathers and mothers following pre-term delivery. Soc Sci Med. 1979;13:139-45.

Franck LS, Cox S, Allen A, Winter I. Measuring neonatal intensive care unit-related parental stress. J Adv Nurs. 2005;49:608-15.

Levy-Shiff R, Sharir H, Mogilner MB. Mother- and father-preterm infant relationship in the hospital preterm nursery. Child Development. 1989;60:93-102.

Affleck G, Tennen H, Rowe J. Infants in crisis: how parents cope with newborn intensive care and its aftermath. New York: Springer-Verlag. 1991;5:97-9.