Parental viewpoints and experiences of therapeutic hypothermia in a neonatal intensive care unit implemented with Family-Centred Care.

AIMS AND OBJECTIVES: To explore parental experiences of therapeutic hypothermia (TH) in their newborn infant suffering from hypoxic ischaemic encephalopathy following perinatal asphyxia. BACKGROUND: Since more than a decade, newborn infants are treated with TH following perinatal asphyxia to reduce mortality and disabilities and to improve neurological outcome. The infants' body temperature is lowered to 33.5°C for 72 hr, and the infant is usually cared for in an open incubator. The parents are not able to hold their infant skin to skin, which risks causing emotional reactions in parents and a loss of normal parent-infant bonding. DESIGN: A qualitative descriptive design using semi-structured interviews. METHODS: Up to 7 months after the event, interviews were conducted with 14 parents of seven infants who had received TH in a neonatal intensive care unit (NICU) in Sweden. The interviews were transcribed and analysed using framework approach. Findings were reported following the Standard for Reporting Qualitative Research (SRQR) checklist. RESULTS: From the interviews, an overall theme was found: Transition through a life-altering time, and three categories: (a) trepidation about prognosis, (b) transitioning into parenthood supported by the caring philosophy of family-centred care (FCC) and (c) rewarming as a milestone. CONCLUSIONS: Parental experiences of TH are based on the immediate emotions and stress of uncertainty of the infant's prognosis. The values of FCC in the NICU append a natural transitioning into parenthood by parental involvement in nursing care and decisions. The rewarming of the infant is seen as a restart to more or less normal circumstances from the critical period of delivery and TH. RELEVANCE FOR CLINICAL PRACTICE: The management of NICUs should update the awareness of and deepen knowledge about FCC. The emphasis ought to be on adequate information about TH and the values of FCC to parents in the NICU context.

Experiences of parents whose newborns undergo hypothermia treatment following perinatal asphyxia.

OBJECTIVE: To describe and interpret experiences of parents whose newborns are treated with induced hypothermia following perinatal asphyxia. DESIGN: A qualitative exploratory study. SETTING: Data collection in parental home environments (n = 8) and in a study room in a university library (n = 2). PARTICIPANTS: A total of 10 parents, seven mothers and three fathers, participated in the study. Their newborns were treated with induced hypothermia 4 to 12 months prior to the interviews. METHODS: Recorded open-ended interviews with the participants lasted from 60 to 90 minutes. Field notes were made after each interview. The interviews were transcribed verbatim and inductive content analysis was used in the analyzing process. RESULTS: Four main themes emerged from the data: emotional landscapes, adaptation to a new situation (with subthemes creating control, external and internal support in a difficult situation, normalizing the abnormal and reconciling oneself to uncertainty), moments of rebirth, and change in attitude toward life and existence. CONCLUSION: Term newborns are treated with induced hypothermia treatment due to perinatal asphyxia. During the hospitalization of newborns in neonatal intensive care units (NICUs), parents experience high levels of stress. Parents use several strategies for adapting to this situation, and nurses play a pivotal role in providing individual support and acting as advocates for parents in the NICU. After the infants are rewarmed, parents experience a moment of rebirth that might help them attach to their infants. Further research is warranted in this area to provide holistic care and support to families whose neonates undergo this treatment.