Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

The Effectiveness of Comfort Care Kits in Relieving Maternal Stress During NICU Stay Begum Acikgoz OMSIII, Brandon Renda OMSIV, Max Muir PGY-1, Lana Maniakhina PGY-1, Nikolai Reitz PGY-1, Imelda Uy MD, Sami Rishmawi MD Spartanburg Regional Medical Center - Neonatal Intensive Care Unit and Edward Via College of Osteopathic Medicine, Spartanburg SC

Abstract #

Background

Our NICU Comfort Kit

Discussion

References Spartanburg Regional Medical Center IRB, 1913485-1, Approval Date: August 24th 2022 Thank you to Dr. David Redden for calculating the statistical analysis for this study We would also like to acknowledge the NICU staff at SRHS for helping us with this study Acknowledgements 1 Alhazzani, W., Aljohani, S., & Almaghrabi, R. (2022). A review of interventions to reduce stress among parents of infants in the neonatal intensive care unit (NICU). https://epag.springeropen.com/articles/10.1186/s43054-022-00138-7 2. American Academy of Pediatrics. (2022). Prematurity profile: Tools and resources for understanding prematurity statistics. March of Dimes. https://www.marchofdimes.org/peristats/tools/prematurityprofile.aspx?reg=99 3. Barry, L. M., & Singer, G. H. (2001). Reducing maternal psychological distress after the NICU experience through journal writing. Journal of Early Intervention, 24(4), 287-297. https://doi.org/10.1177/105381510102400404 4. Lundström, J., Mathe, A., Schaal, B., Frasnelli, J., Nitzsche, K., Gerber, J., & Hummel, T. (2013). Maternal status regulates cortical responses to the body odor of newborns. Frontiers in Psychology, 4. https://doi.org/10.3389/fpsyg.2013.00597 5. Thompson, M., & Anderson, R. (2022). Impact of family dynamics on maternal mental health during NICU stays. ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S1355184122002289 6. Neri, E., De Pascalis, L., Agostini, F., Genova, F., Biasini, A., Stella, M., & Trombini, E. (2021). 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, 18(21), 11361. https://doi.org/10.3390/ijerph182111361 Conclusion Based on our results, it was reported that there was no statistical significance with a p value of 0.0803, between the intervention and the stand of care. Thus, 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. Regarding the limitations, this project should have had a greater sample size for it to accurately represent the general population and a better response rate, particularly for the post-survey responses. For next time, the use of an incentive could have made difference in our data collection. An additional limitation that was present was the use of the Parental Stress Scale Survey without the integration of its three domains including: Sights and Sounds(e.g. presence of constant noises from monitors), Infant Appearance and Behavior and Parental Role Alteration (e.g. the idea of not being able to take care of their child) (Alhazzani et. al., 2022). For future projects, one can explore how the family dynamic can impact a mother’s mental health during her NICU stay by surveying the stress levels of her support system as well. The birth of a child at the right time is linked with such happiness and hope for a new beginning. However, for some mothers, this experience can be overshadowed by neonatal complications that necessitates an expedited delivery. In this sense, it is essential to consider the psychological toll it can have on new moms. Even though our results did not demonstrate statistical significance (p-value>0.05), this project still provided valuable insights into the aspects of healthcare that still needs to be worked on such as the importance of enabling mothers to actively engage in their child’s recovery process. Being able to provide something for the infant’s care (e.g. preemie hat) will further empower their role as a primary caregiver. Moreover, this investigation highlights the significance of maintaining constant communication with the clinicians and offering a platform ,such as routine check-ins, for mothers to clarify any concerns that they may have written down in their journal. In doing so, this will further assist in reducing maternal stress levels that may related to helplessness and alienation.

Fig. 2. Crocheted Baby Octopus Fig. 4. Bonded Hearts

The study was approved by the Spartanburg Regional Institutional Review Board. 64 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. The survey was re administered to both groups two weeks after the initial survey. The data was then statistically analyzed using a two-sample-t-test. 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 comfort kits to mothers. They include toiletries and informational handouts. 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. Hypothesis: Mothers that receive NCK will have reduced stress levels compared to mothers receiving the current standard of care. Our NICU Comfort Kit A journal (Fig. 1): The isolating experience of being in the NICU leaves parents in distress. One way to occupy their time in a healthy manner is to utilize a journal to cope with the situation. 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 levels. 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. 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. 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. (2013) 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. A book: Small but Mighty by Alyssa Veech (Fig. 5): Neri et. Al.(2021) shows that book reading to premature infants helps with future language development. Additionally, parents benefit from the activity by reinstating their role as a caretaker. Notes of encouragement written by VCOM students Methods

Fig.1. Journal

Fig. 5. Book

Fig. 3. Premature Baby Hats

Results

Table 1: Two- Sample T-Test comparing the Pre- and Post-Survey Responses between our NICU Comfort Kit and March of Dimes’ Comfort Kit .

Group Time N Sample Mean Pre 18 30.44 7.15 18.00 Post 18 28.28 7.68 19.00 Delta 18 2.16 6.11 -9.00 Experiment Pre 14 26.14 5.75 18.00 Standard Deviation Control

Minimum

Maximum

46.00 46.00 -12.00 34.00 48.00 12.00

Post 14 28.79 7.96 18.00 Delta 14 -2.65 8.92 -19.00

The p-value was 0.0803. Therefore, our results did not provide statistically significant evidence.

Graph 1: Average Mean Scores for the Pre- and Post-Survey Responses between the NICU Comfort Kit and March of Dimes’ Comfort Kit.

Boxplots for Test Scores Pre to Post by Treatment Group

Test Group = Control

Test Group = Experiment

50

40

30 outcome

20

Pre

Post

Pre

Post

Time

Although the results did not indicate statistical significance, there is a noticeable upward trend in the mean scores of the experimental groups when compared to the control group.

2025 Research Recognition Day

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