title: Parenting very preterm infants and stress in Neonatal Intensive Care Units.
abstract: Assessing parental stress during infants' hospitalization in Neonatal Intensive Care Units (NICU) is essential to identify parents at risk for immediate and extended physical and emotional burden.
  
  
  
  To identify sources of stress in mothers and fathers of very preterm infants hospitalized in NICU, and their association with sociodemographic, obstetric and infants' characteristics.
  
  
  
  Observational and cross-sectional study conducted between July 2013 and June 2014.
  
  
  
  Parents of very preterm infants hospitalized in all level III NICU in the Northern Health Region of Portugal were consecutively and systematically invited to participate in this study, being included 120 mothers and 91 fathers (participation rate: 96.8%).
  
  
  
  The Portuguese version of the Parental Stressor Scale: Neonatal Intensive Care Unit was used.
  
  
  
  The overall experience of hospitalization was classified as more stressful than the median for the subscales. "Change in parental role" was classified as the most stressful subscale by mothers (Median (P25-P75): 4.1(3.2-4.7)) and fathers (Median (P25-P75): 3.2(2.4-4.0)). Mothers scored significantly higher in all subscales. For mothers, multiple pregnancy was associated with lower levels of stress regarding "change in parental role" (β=-0.597; 95% CI=-1.020 to -0.174) and "overall stress" (β=-0.603; 95% CI=-1.052 to -0.153). Being ≥30years old was found to be a significant predictor for decreased fathers' stress.
  
  
  
  This study raises awareness for the need to develop sensitive instruments that take notice of gender, social support and family-centered care. The implementation of interventions focused on reducing parental stress is crucial to diminish disparities in family health.
authors.affiliation: ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, nº 135, 4050-600 Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal. Electronic address: inesbaia@med.up.pt.
authors.forename: Inês
authors.initials: I
authors.lastname: Baía
authors.affiliation: ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, nº 135, 4050-600 Porto, Portugal; Global Public Health Doctoral Programme, Instituto de Saúde Pública, Universidade do Porto, Portugal. Electronic address: mariana.amorim@ispup.up.pt.
authors.forename: Mariana
authors.initials: M
authors.lastname: Amorim
authors.affiliation: ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, nº 135, 4050-600 Porto, Portugal. Electronic address: susilva@ispup.up.pt.
authors.forename: Susana
authors.initials: S
authors.lastname: Silva
authors.affiliation: INSERM UM1027, F-3100 Toulouse, France; Université Toulouse III Paul Sabatier, UM1027, F-3100 Toulouse, France. Electronic address: michelle.kelly@inserm.fr.
authors.forename: Michelle
authors.initials: M
authors.lastname: Kelly-Irving
authors.affiliation: ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, nº 135, 4050-600 Porto, Portugal; Centre for Research and Studies in Sociology (CIES), University Institute of Lisbon, Portugal. Electronic address: claudia_defreitas@yahoo.com.
authors.forename: Cláudia
authors.initials: C
authors.lastname: de Freitas
authors.affiliation: ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, nº 135, 4050-600 Porto, Portugal. Electronic address: elisabete.alves@ispup.up.pt.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Alves
mesh_terms: D000328:Adult; D005220:Fathers / Q000523:psychology; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature / Q000523:psychology*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009035:Mothers / Q000523:psychology; D016487:Parenting / Q000523:psychology*; D012737:Sex Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*
keywords: Infant; Intensive Care Units; Neonatal; Parents; Premature; Psychological; Stress