Document Type : Original Article


Department of Neonatology, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India


BACKGROUND: An infant admitted to the neonatal intensive care unit (NICU) is a potentially
stressful event for parents. Severe stress is experienced by parents, affecting their mental health
and relationship, and infants’ development. The current study aims to assess the stress levels among
parents of neonates admitted to NICU and to identify the factors influencing their stress levels.
MATERIALS AND METHODS: A cross‑sectional study was conducted in a tertiary care hospital
of Eastern India over 2 months. Stress levels were assessed using Parental Stressor Scale: NICU
questionnaire among 100 NICU parents (mother or father) with more than 24 h of admission. Stress
was quantified using the Likert scale. The statistical analysis was performed using the SPSS software.
RESULTS: In this study, 60.8% parents experienced severe and extreme stress level for overall
stress. The mean for overall stress experienced was 3.71 ± 0.70. There was no significant difference
in overall stress between father and mother (P = 0.65). The highest levels of stress experienced were
in sight and sound subscale (3.23 ± 0.41) followed by relationship with the baby and parental role,”
i.e., 2.46 30. There was no significant association in overall stress score with maternal age, parity,
education level, previous baby being admitted to the NICU (P > 0.05). Stress in sight and sound
domain was statistically significantly higher (P = 0.009) among parents of babies with stay of ≤7 days.
CONCLUSION: These results support wider use in research and clinical practice to identify parental
stress. Interventions can be developed to ameliorate its negative effects on individual, interpersonal,
and societal levels. The stress score was not significantly different between fathers and mothers of
neonates admitted to NICU and the length of stay was significantly associated with sight and sound
domain. Appropriate counseling should be targeted toward both parents. Future intervention studies
should be planned to decrease the stress level among parents.


1. Alkema L, Chao F, You D, Pedersen J, Sawyer CC. National,
regional, and global sex ratios of infant, child, and under‑5
mortality and identification of countries with outlying ratios:
A systematic assessment. Lancet Glob Health 2014;2:e521‑30.
2. UNICEF. Levels and Trends in Child Mortality 2017 ‑ UNICEF
DATA. [Last accessed on 2019 Apr 01].
3. Vinod KP. Assess the parental stress among mothers of neonates
admitted in NICU. Int J Appl Res 2017;3:167-8.
4. Wereszczak J, Miles MS, Holditch‑Davis D. Maternal recall of the
neonatal intensive care unit. Neonatal Netw 1997;16:33‑40.
5. Carter JD, Mulder RT, Frampton CM, Darlow BA. Infants
admitted to a neonatal intensive care unit: Parental psychological
status at 9 months. Acta Paediatr 2007;96:1286‑9.
6. Musabirema P, Brysiewicz P, Chipps J. Parents perceptions of
stress in a neonatal intensive care unit in Rwanda. Curationis
7. Miles MS, Funk SG, Kasper MA. The neonatal intensive care unit
environment: Sources of stress for parents. AACN Clin Issues Crit
Care Nurs 1991;2:346‑54.
8. McCormick MC, Workman‑Daniels K, Brooks‑Gunn J. The
behavioral and emotional well‑being of school‑age children with
different birth weights. Pediatrics 1996;97:18‑25.
9. Carter JD, Mulder RT, Darlow BA. Parental stress in the NICU:
The influence of personality, psychological, pregnancy and family
factors. Personal Ment Health 2007;1:40‑50.
10. Palma IE, Von Wussow KF, Morales BI, CifuentesRJ, Ambiado TS.
Stress in parents of hospitalized newborns in a neonatal intensive
care unit. Rev Chil Pediatr 2017;88:332‑9.
11. Sikorova L, Kucova J. The needs of mothers to newborns
hospitalised in intensive care units. Biomed Pap 2012;156:330‑6.
12. Miles MS, Funk SG, Kasper MA. The stress response of mothers
and fathers of preterm infants. Res Nurs Health 1992;15:261‑9.
13. Doering LV, Moser DK, Dracup K. Correlates of anxiety, hostility,
depression, and psychosocial adjustment in parents of NICU
infants. Neonatal Netw 2000;19:15‑23.
14. Dudek‑Shriber L. Parent stress in the neonatal intensive care unit
and the influence of parent and infant characteristics. Am J Occup
Ther 2004;58:509‑20.
15. Lasiuk GC, Comeau T, Newburn‑Cook C. Unexpected: An
interpretive description of parental traumas’ associated with
preterm birth. BMC Pregnancy Childbirth 2013;13 Suppl 1:S13.
16. Woodward LJ, Bora S, Clark CA, Montgomery‑Hönger A,
Pritchard VE, Spencer C, et al. Very preterm birth: Maternal
experiences of the neonatal intensive care environment. J Perinatol
17. Muller‑Nix C, Forcada‑Guex M, Pierrehumbert B, Jaunin L,
Borghini A, Ansermet F. Prematurity, maternal stress and
mother‑child interactions. Early Hum Dev 2004;79:145‑58.
18. Chourasia N, Surianarayanan P, Adhisivam B, Vishnu Bhat B.
NICU admissions and maternal stress levels. Indian J Pediatr
19. Melnyk B, Crean HF, Fischbeck Feinstein N, Fairbanks E. Maternal
anxiety and depression following a premature infants’ discharge
from the NICU: Explanatory effects of the COPE program. Nurs
Res 2008;57:383‑94.
20. Turan T, Başbakkal Z, Özbek Ş. Effect of nursing interventions
on stressors of parents of premature infants in neonatal intensive
care unit. J Clin Nurs 2008;17:2856‑66.
21. Ashwani N, Rekha NA, Suresh Kumar C. Parental stress
experiences with NICU admission in a tertiary care centre. Int J
Psychol Behav Sci 2017;7:27‑31.
22. Herizchi S, Hosseini MB, Ghoreishizadeh M. The impact of
Kangaroo‑Mother care on postpartum depression in mothers of
premature infants. Int J Women’s Heal Reprod Sci 2017;5:312‑7.