|Neonatal Intensive Care Unit Program Reduces
Premature Infants’ Length of Stay and Improves Parents’ Mental
An educational intervention program for parents of infants born
prematurely that is implemented early in the Neonatal Intensive
Care Unit (NICU) can reduce parental stress, depression and anxiety,
enhance parent-infant interactions, and reduce hospital length
of stay, according to a study led by Dr. Bernadette Melnyk, Dean
and Distinguished Foundation Professor in Nursing at Arizona State
University College of Nursing & Healthcare Innovation, Phoenix.
The study, which was funded by the National Institute of Nursing
Research (NINR), a component of the National Institutes of Health,
set out to evaluate the efficacy of an intervention program [Creating
Opportunities for Parent Empowerment (COPE)] that was designed
to make parent-infant interactions a more positive experience and
enhance parent mental health outcomes for the ultimate purpose
of improving child development and behavior outcomes.
Two hundred and sixty families with preterm infants participated
in a randomized, controlled trial conducted from 2001 to 2004 in
two NICUs, in Rochester and Syracuse, New York. Subjects at each
of the two study sites were randomly assigned to receive the COPE
program or a comparison intervention program.
The researchers describe COPE as a four-phase educational-behavioral
intervention program, with each phase providing parents with information
- The appearance and behavioral characteristics of premature
infants and how parents can participate in their infant’s care,
meet their infant’s needs, make interactions with their infant
a more positive experience, and aid in their infant’s development;
- Activities that assist parents in implementing the experimental
information, such as recognizing their infants’ alert states
and stress cues, and identifying special characteristics of their
Phase I of the COPE program occurred 2 to 4 days after the infants’ admission
to the NICU; Phase II occurred 2 to 4 days after completion of
Phase I; Phase III occurred 1 to 4 days before discharge; Phase
IV was delivered in the parents’ home 1 week after infant discharge.
The investigators packaged the intervention as audiotaped and
written information along with prescribed activities so that it
could be easily reproduced and administered to all parents of preterm
infants in NICUs at low cost. Their goal was for the COPE program
to achieve widespread use without requiring intensive staff training
The study, which appears in the November issue of Pediatrics,
found that mothers in the COPE program reported significantly less
stress in the NICU and less depression and anxiety than mothers
in the comparison group when evaluated 2 months following the intervention.
Trained observers in the study rated mothers and fathers in the
COPE program as more positive in interactions with their infants.
Mothers and fathers also reported stronger beliefs about their
parental role and what behaviors and characteristics to expect
of their infants during hospitalization. Also, infants in the COPE
program had a 3.8-day shorter NICU length of stay and a 3.9-day
shorter total hospital length of stay than did comparison infants.
In addition, for very low birth weight infants in the study (those
less than 1500 grams), the COPE infants had an eight-day shorter
length of stay than comparison infants.
The researchers also report that the COPE group’s shortened hospital
stay resulted in decreased hospital costs of $5000 per infant (4
days x $1,250/day). They further note that with 480,000 low birth
weight premature infants born every year in the U.S., approximately
$2.4 billion could be saved annually within our national health
care system if the COPE program were to be adopted by NICUs across
According to the investigators, this is believed to be the first
randomized controlled trial to demonstrate that a reproducible
theory-based intervention with parents of premature infants that
commences early in the NICU produces less parental stress in the
NICU, more positive parent-interactions in the NICU, less parental
anxiety and depressive symptoms following hospitalization, and
reduced length of stay for preterms.
“This study demonstrates the important role that nurse scientists
can play not only in helping families cope during a highly stressful
period in their lives, but also in contributing to a family’s long-term
quality of life and well being,” said Dr. Patricia A. Grady, Director,
National Institute of Nursing Research.
The research team is continuing to follow these children and their
parents to determine if these lower patterns of depressive and
anxiety symptoms will continue over time through 3 years of age
or escalate as developmental changes occur and lags in infant development
Dr. Melnyk and her team point out that “interventions such as
the COPE program, targeted to lessen depressive symptoms, are especially
important in that depressed mothers have been found to be less
responsive, affectionate, and positive during interactions with
their infants, which leads to later adverse child outcomes. Specifically,
maternal depression has been empirically linked with family violence,
marital discord, impaired cognitive development, child abuse and
neglect, and childhood mental health and behavior disorders.” “Despite
the high incidence of maternal depression in women with premature
infants, these women rarely seek professional assistance for their
condition, often unaware of their symptoms or minimizing them,” they
Dr. Melnyk’s key research collaborators include Dr. Nancy Feinstein,
Dr. Linda Alpert-Gillis, Eileen Fairbanks, Dr. Hugh Crean, and
Dr. Xin Tu, University of Rochester, New York; Dr. Leigh Small,
Arizona State University College of Nursing and Healthcare Innovation;
Dr. Robert Sinkin, The University of Virginia Medical Center; Dr.
Steve Gross, Crouse Hospital in Syracuse, New York; and Dr. Pat
Stone, Columbia University, New York.
The primary mission of the NINR, one of 27 Institutes and
Centers at the National Institutes of Health, is to support clinical
and basic research and establish a scientific basis for the care
of individuals across the life span. For additional information,
visit the NINR web site at http://ninr.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.