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Memories of Infant Pain in the Neonatal Intensive Care Unit Influence Posttraumatic Stress Symptoms in Mothers of Infants Born Preterm

Vinall, Jillian, PhD*; Noel, Melanie, PhD†,‡; Disher, Timothy, BScN, RN§; Caddell, Kim, RN, BN§; Campbell-Yeo, Marsha, PhD, NNP-BC, RN§,∥,¶

doi: 10.1097/AJP.0000000000000620
Original Articles

Objectives: The birth of a preterm infant and witnessing ones’ infant in pain is remembered by parents as being one of the most stressful aspects of the neonatal intensive care unit (NICU). Elevated posttraumatic stress symptoms (PTSS) are highly prevalent among mothers of preterm infants, however, little is known about mothers’ memories of invasive procedures in the NICU and how these memories may contribute to the development of PTSS. We examined the relationships between number of invasive procedures, mothers’ memories of these procedures, and their PTSS at discharge from the NICU.

Materials and Methods: Participants included 36 mothers of infants born below 37 weeks gestational age recruited from a tertiary-level NICU. Medical chart review was performed between birth and discharge from the NICU. At discharge, a research nurse conducted a structured memory interview with the mothers to assess their memories of their infants’ invasive procedures. Mothers also completed a self-report measure of PTSS (Posttraumatic Stress Disorder Checklist for the DSM-5).

Results: Mothers of infants exposed to greater numbers of invasive procedures had more elevated PTSS at discharge (R 2=0.37). Moreover, mothers who recalled having greater anxiety about their infant’s invasive procedures had greater symptoms of reexperiencing (R 2=0.34) and avoidance (R 2=0.28) at discharge from the NICU.

Discussion: Greater neonatal exposure to invasive procedures and mothers’ recall of these procedures were related to mothers’ posttraumatic stress symptomatology at discharge. Invasive procedures in the NICU represent an important target area for neonatal intervention to reduce maternal distress and improve outcomes.

Departments of *Anesthesia

Psychology, University of Calgary

Behaviour and the Developing Brain Theme, Alberta Children’s Hospital Research Institute, Calgary, AB

§Centre for Pediatric Pain Research

Departments of Pediatrics, Psychology, Neuroscience, IWK Health Centre

School of Nursing, Dalhousie University, Halifax, NS, Canada

Clinical Trial registry name and registration number: Trial of Repeated Analgesia with Kangaroo Care (TRAKC) NCT01561547.

Funding for this study was obtained through the Canadian Institutes of Health Research, the Nova Scotia Health Research Foundation, and the Mayday Foundation. M.C.-Y. is supported by a Canadian Institutes of Health Research (CIHR New Investigator Award) and Canadian Child Health Clinician Scientist Career Development Award, Halifax, NS, Canada. M.N. is supported by CIHR, the Alberta Children’s Hospital Research Institute (Vi Riddell Pediatric Pain Initiative), American Pain Society, Society of Pediatric Psychology, Alberta Health Services, Calgary, AB, Canada. J.V. is supported by Fellowships from the Louise and Allan Edward Foundation and CIHR, Calgary, AB, Canada. T.D. is supported by a Canada Graduate Scholarships Vanier award, a Killam predoctoral scholarship, and a Nova Scotia Health Research Foundation Scotia Scholars award, Halifax, NS, Canada. The authors declare no conflict of interest.

Reprints: Marsha Campbell-Yeo, PhD, NNP-BC, RN, Dalhousie Univeristy Ave, P.O. Box 9700, Halifax, NS, Canada B3K 6R8 (e-mail:

Received July 24, 2017

Received in revised form April 10, 2018

Accepted April 11, 2018

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