VCOM Carolinas Research Day 2023

Clinical Studies

The Effectiveness of Comfort Care Kits in Relieving Maternal Stress During NICU Stay Lana Maniakhina OMSIII, Nikolai Reitz OMSIII, Brandon Renda OMSII, S. Max Muir OMSIII, Ashley Cummings BSN, Imelda Uy MD, Sami Rishmawi MD Spartanburg Regional Medical Center - Neonatal Intensive Care Unit and Edward Via College of Osteopathic Medicine, Spartanburg SC Background NICU Comfort Kit

Abstract # CLIN-14


A journal (Fig. 1) The isolating experience of being in the NICU leaves parents in distress. They are not allowed to bring many items into the room. One way to occupy their time in a healthy manner is to utilize a journal to cope with the situation. Barry et. al. And other studies have shown that journaling decreased maternal distress. Crocheted Baby Octopus (Fig. 2) Crocheted octopus contains numerous tentacles that resemble the umbilical cord. Neonates find comfort in holding the umbilical cord during gestational period. However, premature labor hinders the newborn from performing this innate activity. Hence, providing an octopus that resembles the umbilical cord may alleviate stress and provide a level of comfort to the newborn. Furthermore, Smith et al, shows that parents feel more involved in the care of the baby. Premature baby hat (Fig. 3) A hat will help the infant maintain body temperature. The head is the largest surface area on a baby and therefore it is the area with the most heat loss. A hat keeps the baby warm and decreases the heat lost from the scalp. This has been used in practice for many decades. Hats also play a cosmetic role. It is well known that babies may not be visually appealing to everyone post-labor and hats have been used to provide a more appealing visual appearance. The hat is an item that the mother can give to the infant and provides a way for the mother to engage in caretaking activities of the new infant. This empowerment of having something to provide for the infant’s care will hopefully decrease the mother’s stress and feelings of helplessness. Bonding Hearts (Fig. 4) The Bonding Hearts is a scented cloth in the form of the heart that can be switched between mother and baby to provide a sense of smell. Research by Lundstrom et. al. has shown that maternal brain activity was seen in the thalamus when exposed to the body odor of a newly born infant. Evidence also showed that body odor from two-day old newborn activated reward-related cerebral areas in women. Hopefully by providing this in the kit it can play a role in decreasing maternal stress levels. A book: Small but Mighty by Alyssa Veech (Fig. 5) Neri et. Al. shows that book reading to premature infants helps with future language development. Additionally, parents benefit from the activity by reinstating their role as a primary caregiver. Notes of encouragement written by VCOM students

Preterm infants with very low birth weight carry a 25% mortality rate due to many short- and long-term complications. They require admission to the Neonatal Intensive Care Unit (NICU) for close monitoring and physical isolation. This places a great amount of stress on the mothers. Currently, the March of Dimes organization offers support and comfort kits to mothers. They include toiletries, chapstick, water, gum, and other items. While the services are appreciated by the families, additional items could potentially reduce the emotional burden on the mothers during a stressful stage of their life. The research on maternal stress in NICU is scarce. However, after interviewing mothers with premature infants and researching specific items, a new comfort kit was compiled. The NICU Comfort Kit (NCK) is comprised of a neonatal book, journal, crocheted baby octopus, bonding hearts, note of encouragement, and premature baby hat. All of these items are meant to encourage bonding between the mother and her child. Mothers that receive NCK will have reduced stress levels compared to mothers receiving the current standard of care.


The study was approved by the Spartanburg Regional Institutional Review Board. Seventy NICU mothers who fall into the 18-35-year-old age range and gave birth to infants less than or equal to 1499 grams were recruited. They were asked to complete a Parental Stress Scale (PSS) survey within the first 48 hours of birth. Then the intervention (NCK) was administered to half of the subjects. The other half of the subjects received the current standard of care, the March of Dimes' comfort kit contributions to the hospital. The survey is re administered to both groups two weeks after the initial survey. After two weeks the NCK group also receives the March of Dimes’ comfort kit, as standard of care.

Conclusion This study is currently in progress and results are not determined. Not enough data has been acquired to differentiate between our intervention and the null hypothesis. It is our hope that this research and more like it will shed light on ways in which we can help mothers to cope with the enormous stress of having a child in the NICU.


• Barry LM, Singer GHS. Reducing maternal psychological distress after the NICU experience through journal writing. Journal of Early Intervention . 2001;24(4):287-297. doi:10.1177/105381510102400404 • Berry JO, Jones WH. The Parental Stress Scale: Initial Psychometric Evidence. Journal of Social and Personal Relationships . 1995;12(3):463-472. doi:10.1177/0265407595123009 • Chourasia N, Surianarayanan P, Adhisivam B, Vishnu Bhat B. NICU Admissions and Maternal Stress Levels. The Indian Journal of Pediatrics . 2012;80(5):380-384. doi:10.1007/s12098-012-0921-7. • Lundström J, Mathe A, Schaal B, Frasnelli J, Nitzsche K, Gerber J, Hummel T. Maternal status regulates cortical responses to the body odor of newborns. Frontiers in Psychology . 2013 Sep 05; 4. doi:10.3389/fpsyg.2013.00597 • Neri E, De Pascalis L, Agostini F, Genova F, Biasini A, Stella M, Trombini E. Parental Book-Reading to Preterm Born Infants in NICU: The Effects on Language Development in the First Two Years. International Journal of Environmental Research and Public Health . 2021; 18(21):11361. doi:10.3390/ijerph182111361 • Smith A, Tamgumus S, Lawless S, Penrose P, EL-Khuffash A, Boyle MA. Tentacles For Tinies: The Many Arms of the Crocheted Octopus. Irish medical journal . 2018;111(8):812.

Fig. 2. Crocheted Baby Octopus

Fig. 3. Premature Baby Hats

Fig.1. Journal


Spartanburg Regional Medical Center IRB, 1913485-1, Approval Date: August 24th 2022 Thank you to Angie Wilson for calculating the power analysis for this study We would also like to acknowledge the NICU staff at SRHS for helping us with this study

Fig. 4. Bonded Hearts

Fig. 5. Book


2 0 2 3 R e s e a r c h R e c o g n i t i o n D a y

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