title: Very preterm birth: maternal experiences of the neonatal intensive care environment.
abstract: OBJECTIVE
  Examine sources, predictors and child outcomes associated with neonatal intensive care unit (NICU)-related stress for mothers of infants born very preterm (VPT).
  
  
  METHODS
  Participants were 133 mothers of VPT infants admitted to a regional level-III NICU. At term equivalent, mothers completed the Parental Stressor Scale: NICU and were interviewed about their psychological well-being and family circumstances. Infant clinical data were also collected. At corrected age 4 years, 49 children were assessed for cognition, language and socio-emotional development.
  
  
  RESULTS
  Mothers reported moderate to low stress, with parental role alteration considered most stressful and parent-staff communications least stressful. Predictors of overall stress included maternal educational underachievement, stressful life events, postnatal depression and infant unsettled-irregular behavior. NICU-related stress was associated with child anxiety and poorer language development.
  
  
  CONCLUSIONS
  Parental well-being is an important focus of care in the neonatal setting. Strategies are needed to optimize early engagement and reduce stress levels to assist improved child outcomes.
authors.affiliation: 1] Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA [2] Department of Psychology, University of Canterbury, Christchurch, New Zealand.
authors.forename: L J
authors.initials: LJ
authors.lastname: Woodward
authors.affiliation: Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Bora
authors.affiliation: Department of Psychology, Prevention Science Institute, University of Oregon, OR, USA.
authors.forename: C A C
authors.initials: CA
authors.lastname: Clark
authors.affiliation: Department of Psychology, University of Canterbury, Christchurch, New Zealand.
authors.forename: A
authors.initials: A
authors.lastname: Montgomery-Hönger
authors.affiliation: Department of Psychology, Aberystwyth University, Ceredigion, Wales, UK.
authors.forename: V E
authors.initials: VE
authors.lastname: Pritchard
authors.affiliation: Neonatal Service, Christchurch Women's Hospital, Christchurch, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Spencer
authors.affiliation: 1] Neonatal Service, Christchurch Women's Hospital, Christchurch, New Zealand [2] Department of Pediatrics, University of Otago, Christchurch, New Zealand.
authors.forename: N C
authors.initials: NC
authors.lastname: Austin
mesh_terms: D000328:Adult; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000523:psychology*; D008297:Male; D009035:Mothers / Q000523:psychology*; D009520:New Zealand; D013315:Stress, Psychological