Health Problems of Low Birth Weight Babies on Family and Society

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• Published: 16 February 2017

The impact of preterm nascency <37 weeks on parents and families: a cantankerous-exclusive study in the 2 years after discharge from the neonatal intensive intendance unit

• Meghana Agni^v,
• Tracy Lieu⁶,
• Eric Fleegler^seven,
• Michele Kipke⁸,
• Philippe S. Friedlich¹,
• Marie C. McCormick^9,10,11 &
• Mandy B. Belfort¹²

Health and Quality of Life Outcomes volume 15, Commodity number:38 (2017) Cite this commodity

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Abstract

Background

Piddling is known nearly the quality of life of parents and families of preterm infants after belch from the neonatal intensive care unit of measurement (NICU). Our aims were (i) to describe the impact of preterm nativity on parents and families and (two) and to identify potentially modifiable determinants of parent and family unit touch.

Methods

We surveyed 196 parents of preterm infants <24 months corrected age in three specialty clinics (82% response charge per unit). Main outcomes were: (ane) the Impact on Family unit Scale total score; and (2) the Infant Toddler Quality of Life parent emotion and (3) time limitations scores. Potentially modifiable factors were use of community-based services, financial burdens, and health-related social bug. We estimated associations of potentially modifiable factors with outcomes, adjusting for socio-demographic and infant characteristics using linear regression.

Results

Median (inter-quartile range) infant gestational age was 28 (26–31) weeks. Higher Affect on Family scores (indicating worse effects on family functioning) were associated with taking ≥3 unpaid hours/week off from work, increased debt, financial worry, dangerous home environment and social isolation. Lower parent emotion scores (indicating greater bear upon on the parent) were likewise associated with social isolation and unpaid time off from work. Lower parent fourth dimension limitations scores were associated with social isolation, unpaid time off from work, financial worry, and an dangerous home environment. In contrast, higher parent fourth dimension limitations scores (indicating less impact) were associated with enrollment in early on intervention and Medicaid.

Conclusions

Interventions to reduce social isolation, lessen financial burden, amend home prophylactic, and increase enrollment in early intervention and Medicaid all accept the potential to lessen the impact of preterm birth on parents and families.

Background

In the United States, nearly 500,000 infants, or eleven.7% of all live births, are born preterm (<37 weeks' gestation) each year [1, ii]. Preterm nascency and the sometimes associated prolonged newborn hospitalization are not bad family stressors, and can lead to subsequent family dysfunction [3–5].

All preterm infants are at risk for re-hospitalization, as well equally medical and neurodevelopmental complications, fifty-fifty moderate to tardily preterm infants (built-in at 32 to <37 weeks' gestation) [6]. A particularly challenged sub-group is very low nascency weight (VLBW) infants or those born < 1500 g. More than than 90% of VLBW infants are discharged dwelling from the neonatal intensive intendance unit (NICU). The brunt of continued health and developmental problems faced by these infants is substantial [7–9]. For example, compared with normal birth weight children, VLBW children face a 2–three fold greater risk for visual and hearing damage, speech communication delays and attention disorders [10, 11]; may have poor feeding and growth, respiratory complications, and face up neurocognitive difficulties [12–16].

Given these ongoing problems and risks, families of preterm children oft must manage numerous medical and developmental needs above and beyond what is required for a healthy total term infant, for months or even years after the neonatal discharge. For instance, during the first yr of life, VLBW infants are prone to re-hospitalization and crave increased outpatient care [17–19]. Parents must transport their child for medical appointments and therapies, communicate with the child's pediatrician and other healthcare providers, and are frequently responsible for daily tasks, such as administering medications and monitoring chronic conditions.

The intensity of care and loftier level of vigilance required by families to run across the needs of their preterm child makes it likely that having a preterm child adversely affects the quality of life of the parents and the family unit overall. The 2006 Institute of Medicine's (IOM) report on Preterm Nascency: Causes, Consequences and Prevention stressed the importance of assessing aspects of family and parent quality of life and stress beyond maternal psychological well-beingness [twenty–22]. A better agreement of the impact of preterm birth on parent and family quality of life, every bit well as modifiable factors that predispose parents and families to greater or bottom impact would inform community-based and other structured assistance programs designed to lessen the impact.

Our main research question was, "Are modifiable characteristics (such as the use of community based and public assistance programs, fiscal burden, and health related social issues) associated with the impact of preterm nativity on parents and families after NICU belch?" The Anderson and Aday health utilization model [23, 24] provides a useful framework for addressing our research question because it uniquely captures the constructs of admission, need, and quality of life. As presented in Fig. ane, nosotros conceptualized potentially modifiable characteristics that influence parent and family unit bear on as: (ane) utilise of community based developmental services and public help programs; (2) financial brunt; (iii) health related social problems. We also specified predisposing characteristics (including socio-demographics and infant wellness characteristics) related both to modifiable characteristics and to outcomes that could human action as confounders.

Fig. 1

Conceptual Model. Adapted from Phillips [74]

Full size prototype

Our specific aims were (1) to describe the touch of preterm birth on parents and families and (2) and to identify potentially modifiable determinants of parent and family bear on. Specific variables of interest based on previous literature, were employ of community-based resource, financial brunt and wellness-related social problems [25].

Methods

Study pattern and participants

This was a cantankerous-sectional study. Nosotros enrolled one parent (mother or male parent) of preterm (<37 weeks gestation) infants attending three outpatient clinics at a large third children's infirmary. One dispensary provides multidisciplinary medical and neurodevelopmental follow-upwardly for infants with gestational historic period <32 completed weeks or birth weight <1500 m discharged from 1 of three large, academic NICU'south and affiliated community-based Level Ii nurseries, and for more mature or heavier preterm infants with severe medical weather condition and/or social gamble factors (101 participants enrolled). The 2d clinic provides pediatric pulmonary care for infants with lung disease that originates in the newborn menses, predominantly bronchopulmonary dysplasia (57 participants enrolled). The 3rd clinic provides follow-up care for infants who have suffered neurologic injury during the fetal or newborn menstruation (38 participants enrolled). While some patients were seen at more than than one clinic, they were only enrolled once in the study.

We included parents of preterm infants who were up to 24 months corrected age (historic period from term equivalent). Parents must accept been able to answer questions in English or Spanish. If the infant was a multiple, only i response was collected from the family. Study staff provided eligible families with a letter describing the written report. Consent was obtained when the parent agreed to complete the questionnaire, which was administered on a laptop (with privacy screens) in the clinic waiting room or examination room. Participants were provided a minor incentive to complete the survey.

The Boston Children'south Infirmary and Children's Infirmary Los Angeles human subjects committees approved the written report protocol. Approximately 75% of preterm infants are referred to high-risk infant follow up programs. [iii] In this study, of the 239 eligible participants from October, 2011 to June, 2012, 196 completed the questionnaire (82% response rate). The questionnaire is available equally Additional file ane.

Measurements

Measurements of primary outcomes, modifiable characteristics and potential confounders (predisposing characteristics) are summarized in Additional file 2: Table S1.

Impact on family

The Bear upon on Family (IOF) [26–28] measures the global touch on of pediatric disability on the family and has been validated on samples of children with chronic health conditions, including preterm birth [25]. The IOF total score is derived from a 27-item questionnaire. For each item, parents indicate the extent to which they agree with a statement regarding the negative touch on of the child on the family. Anchors for a 4-bespeak Likert scale were: strongly agree; agree; disagree; and strongly disagree. Examples of IOF items are: "The illness is causing financial bug for the family" and "Our family gives upwards things because of illness." IOF subscales include financial impact (8 points), disruption of planning (20 points), caretaker burden (12 points), and familial burden (sixteen points) for full possible score of 56 points. The total negative bear upon score served as our summary measure of family burden (college scores indicate greater family unit brunt).

In a previous written report, internal consistency was loftier for the overall IOF Scale (Cronbach alphas for total impact, 0.83 to 0.89), but lower for financial (0.68 to 0.79) and coping (0.46 to .52) items [26]. High total scores on the IOF are associated with maternal psychiatric symptoms, poor child wellness, poor child adjustment, increased child hospitalizations, lower maternal education, and maternal receipt of public assist [27–29], providing show for construct validity.

Impact on parent

The Baby Toddler Quality of Life Questionnaire™ (ITQOL) was developed in 1994 for use in children from 2 months to v years of age as a "contour mensurate" for health status and health-related quality of life. ITQOL adopts as its conceptual framework the Globe Health Organization's definition of health as a state of consummate physical, mental and social well-being and not just the absence of affliction [30]. It has been used both in randomized clinical trials [31] and observational studies, and is accustomed favorably for its ease of use and understandability [32].

In this study, we used the Family unit Burden scales of the ITQOL, which encompass 2 parent-focused concept subscales, affect-emotion and touch-time, due to caring for their infant or toddler [30, 32, 33]. The parent impact-emotion domain consists of seven items in which the parent is asked to rate how much anxiety or worry each of the child characteristics described in the items has caused during the by 4 weeks (i.e., feeding/sleeping/eating habits; physical health, emotional well existence, learning abilities, ability to interact with others; behavior and temperament). The parent touch on-time domain consists of seven items in which the parents is asked to charge per unit how much of his/her time was express for personal needs because of the issues with the child'due south personal needs during the past 4 weeks. Internal consistency for the ITQOL parent-impact emotion and parent-impact time scales has been reported in three different populations, a Dutch full general population sample (0.61, 0.64) [34], a functional abdominal pain sample (0.72, 0.73) [35] and a burn injury sample (0.79, 0.84) [30, 36].

Raw subscale scores are converted to standardized scores on a 0–100 continuum [37–forty]. For each scale, college scores point less emotional touch and fewer time limitations on the parent (in other words, higher scores represent more favorable outcomes).

Potentially modifiable characteristics

Employ of community-based resource

Participants were asked yes/no questions about the use of community-based developmental resources (such every bit early intervention programs), use of social services such as food assistance programs, Supplemental Diet Aid Program and the Women, Infant, Children's program as well as free energy assistance/disability programs such the Low Income Home Energy Assist Plan, Transitional Aid to Families with Dependent Children, and receipt of Supplemental Security Income (SSI).

Fiscal Burden

In addition to questions nigh employment for the participating parent and his/her partner, we asked 6 yes/no questions from the 2007 Democracy Fund Biennial Health Insurance Survey [41–44] regarding unexpected costs, increased bills, increased out-of-pocket expenses and financial worry.

Health-related social problems

HelpSteps.com is a survey designed to identify health-related social issues. Development of HelpSteps involved literature review and fundamental informant interviews with wellness and social services experts, yielding an initial list of 25 social domains. Of those, the five near relevant domains were identified using a modified Delphi technique: (i) access to wellness care, (2) housing, (3) food security (4) income security and (five) intimate partner violence [45–48]. Most questions near these domains were adapted from previous surveys (e.g. National Wellness Interview Survey [49], the American Housing Survey [50], the Philadelphia Survey of Work and Family [51] and the Childhood Community Hunger Identification Project [52]), while a few newly written items were likewise incorporated into the terminal HelpSteps survey. In terms of content validity, the domains covered in HealthSteps are well-recognized equally being closely tied to health outcomes and costs [53]. HelpSteps is highly constructive in identifying problems that can be addressed by referral to advisable social services [46, 47] and a qualitative study revealed that over 2/3 of participants found the HealthSteps questions to be highly relevant to their own issues [48].

Predisposing characteristics (potential confounders)

Infant wellness and development

Nosotros obtained information from the medical record regarding commitment and complications during the neonatal hospitalization. We asked parents questions nigh their infant's health status since belch including the number of emergency department visits, monthly clinic appointments, and hospitalizations, immunizations, dependence on engineering, and administration of prescription medications.

To assess infant evolution, we used the Motor and Social Development (MSD) scale [54], which was developed by the National Center for Health Statistics to measure motor, social and cognitive development of young children. Of 48 items derived from standard measures of child evolution, including the Bayley Scales, Gesell Scale, and Denver Developmental Screening Exam, parents complete xv age-specific items, which inquire most specific developmental milestones such every bit laughing out loud, pulling to stand, and maxim recognizable words [55]. We selected the MSD because it is brief and allows for scoring based on a big, national sample [56] with a normative mean of 100 and standard divergence 15, similar to other developmental tests. Higher scores betoken meliorate development. In a previous written report of sometime preterm infants, nosotros showed that the MSD has practiced internal consistency (Cronbach alpha 0.65-0.88) and is modestly correlated with Bayley Scales of Infant and Toddler Devleopment, 3^rd edition, a gold standard professionally administered neurodevelopmental test [56]. Another written report reported that infants with lower gestational age at nascence take lower scores on the MSD [54]. Although the MSD includes a cognitive, motor, and social subscales, the degree to which it is sensitive to language/communication delays is unknown, which is a potential limitation.

Statistical analysis

Our principal outcomes were: (1) affect on family unit full score; (2) impact on parent score determined by the concept of emotion; and (3) bear on on parent score determined past the concept of limitation of time. Potentially modifiable determinants included the use of community-based resources, financial burden, and wellness-related social problems. Potential confounders (predisposing characteristics) were socio-demographics and infant pre-disposing and post-belch characteristics.

In bivariate analyses, we compared issue scores across categories of predisposing characteristics (potential confounders) and potentially modifiable determinants. We calculated p-values using non-parametric tests (Wilcoxon Rank Sum or Kruskal Wallis). To place potentially modifiable determinants independent of confounders on our principal outcomes, we created parsimonious multivariable models, adjusting for variables of a priori interest and for other characteristics found to exist significant at p <0.1. We also examined each model using variance inflation factors (VIF) and did not notice meaning collinearity (VIF ≤ ii for all models).

We used SAS version 9.4 (SAS Establish Inc., Cary, NC) for analyses.

Results

Participant characteristics and outcomes

Predisposing characteristics of report participants and outcome measures are shown in Table 1. A bulk of participants were white, non-Hispanic (67%). 52% reported an annual household income of ≥ $80,000 and 68% of mothers had attended at least some college. The median (IQR) gestational age of infants at birth was 28 weeks (26–31). The median (interquartile range, IQR) chronologic historic period of infants at the time of study participation was 10.4 months (seven.5-17.2).

Tabular array 1 Pre-disposing characteristics and unadjusted associations with impact on family and impact on parent scores (north = 196)^a

Full size table

Unadjusted associations of predisposing characteristics (potential confounders) with outcomes

As shown in Tabular array 1, amidst pre-disposing characteristics, the use of medical technology, receipt of at least 1 prescription medication daily, one or more readmission or emergency department visit after neonatal discharge, and 2 or more than clinic appointments per calendar month were all associated with greater bear on on family, parents, or both. Additionally, having an infant with a low developmental score (MSD < 85) was associated with greater impact on the family unit and parent emotion. Fathers who completed the survey had higher bear on scores than mothers on the parent-focused domains of emotion and time limitations. Of notation when we performed an boosted sensitivity analysis past running our multivariate models for mothers just, we found our multivariate model estimates were like in magnitude and management as the total models that included fathers.

Potentially modifiable characteristics and unadjusted associations with outcomes

Table ii shows that apply of public housing and public assistance program were associated with greater impact on family unit. Compensation for time taken off from piece of work was associated with a lower parent emotional score (less parental impact) while use of social services, public housing, enrollment in Medicaid and an unsafe home environment were associated with a higher IOF score (greater family bear upon). Markers of financial burden (including unpaid time off work, increased out-of-pocket expenses, bills, debt and financial worry) and social isolation were associated with both greater family and parental bear on.

Table two Potentially modifiable characteristics and unadjusted associations with touch on on family and touch on on parent scores (n = 196)^a

Full size table

Adjusted associations of potentially modifiable characteristics with outcomes

Table 3 shows associations of potentially modifiable characteristics with the total IOF Scale scores, adjusting for potential confounders. Taking time off from work without pay, increased bills, financial worry, an dangerous dwelling house environment, and social isolation were all associated with higher full IOF scores, indicating greater impact. Similarly, Table iv shows adapted associations of potentially modifiable characteristics with impact on Parent Emotion and Time Limitation scores. Taking time off from work without pay and social isolation were associated with lower scores on both of these scales, indicating greater bear upon. Fiscal worry was associated with greater touch on on parent time limitation, equally was an unsafe home environment. In contrast, enrollment in early on intervention and Medicaid programs were associated with higher parent time limitation scores, indicating less parental impact.

Table three Adjusted associations of potentially modifiable characteristics with total bear on on family unit scores (n = 196)

Full size table

Table four Adjusted associations of potentially modifiable characteristics with bear upon on parent emotion and time limitation scores (due north = 196)^a

Full size table

Give-and-take

In this study, we described the impact of preterm nascence on parents and families in the first 2 years afterwards neonatal discharge. Our results support our conceptual model, which posits modifiable factors that are associated with the impact of preterm nascency on parents and families, independent of infant wellness and socio-demographic characteristics. Nosotros identified several potentially modifiable factors that were associated with both higher and lower impact. In particular, social isolation, financial burdens such as taking unpaid time off from work, increased bills and financial worry, and an unsafe dwelling house environment were all associated with higher impact on at least i of our principal outcomes. In dissimilarity, enrollment in early intervention and Medicaid and utilize of public housing were associated with less parent bear on.

Predisposing characteristics such as infant co-morbidities afflicted both impact on family scores and parental scores. Infant development affected parental scores for increased feet and emotion. Our findings were consequent with previous studies that the impact was greater amid families whose preterm children demonstrated either a functional handicap or low developmental quotient [22, 25, 57–59]. We besides found that the utilise of prescription medications and durable medical equipment affected both parental touch scores and impact on family scores, which was consistent with other publications [20, 60]. Specifically, the use of medications and medical equipment may contribute to the substantial out-of-pocket expenditures that families may incur [61, 62]. Equally pressure mounts to reduce hospital length of stay and readmission rates, and every bit we move more than complex care into the community, high out-of-pocket costs is an important factor that tin contribute to parental and family strain.

Several studies take shown that preterm birth and an infant's hospitalization can adversely touch on the finances of families after the birth of a preterm or VLBW infant [20, 60–63]. However, little is known about a more than modifiable determinant such as the specifics of financial burden faced by families, or nearly the bear upon of financial burden on parent quality of life. In our study, we constitute that a lack of bounty for fourth dimension off work was associated with both family and parent-time impact scores. As well, increased bills due to hospitalization and increased financial worry were associated with greater bear on. Complementing our findings, 2 studies take reported the out-of-pocket costs incurred by families of preterm infants for outpatient services, medications, likewise every bit indirect costs like lost productivity are significant especially during the kickoff year after discharge [60, 64]. Specifically, Hodek et al. cited that co-payments for outpatient ancillary services and medications increased parental out-of-pocket expenses. Moreover, lost wages for missing work days may increase income losses [60]. Overall, by highlighting the specific aspects of financial burden most closely associated with parent and family bear on, such as lack of compensation and increased bills, our results may inform targeted financial support programs for families of preterm infants after discharge. Moreover, our findings back up that while annual income was not associated with impact on family, parental perspective on fiscal burden was, which should likewise be considered when caring for these families.

Another modifiable determinant are wellness related social problems. These are economic and social problems that tin can affect health such every bit nutrient insecurity and substandard housing [45]. Prior studies have demonstrated the touch of substandard housing on child wellness such every bit increased communicable diseases and injury [65]. All the same, we found that an unsafe dwelling house environment was associated with agin parent-time affect and impact on the family. Timely receipt of public housing has been associated with improved health in other medical condtions [66]. Addressing housing concerns for families of preterm infants through existing public housing programs is a feasible approach to reducing the parental and family affect.

Another health related social problem that was associated with greater parental and family unit impact was social isolation. Other studies that have examined families of premature infants have found that "alienation" [67] and social isolation may take profound bear upon on parental emotion [68]. Jackson et al. described the image of the process of acclimatization of caring for a premature baby as breach, responsibility, confidence and familiarity, and that alienation may be protracted in this population [67]. Intervention strategies that have improved parental emotions oftentimes include education-behavioral models. For case, the Creating Opportunities for Parent Empowerment (COPE) program created by Melnyk, et al. was associated with reduced parental impact during transition abode from the NICU [69, 70]. It is possible that programs like that one benefit families past reducing social isolation in months to years after discharge.

Another modifiable determinant is enrollment in a customs-based developmental program similar "Early Intervention (EI)," was associated with less impact on parental limitation of time. A recent meta-analysis suggests that customs-based developmental programs had beneficial pooled effects on maternal feet, depressive symptoms, and self-efficacy [71]. Moreover, other studies have suggested that these programs can also empower families because of the collaborative procedure that EI offers; in turn, they take a deeper understanding of their child's developmental needs [72].

Similarly to early intervention, we constitute that receipt of Medicaid was associated with lower impact scores on limitations on time. Other studies take demonstrated families who were registered with Medicaid showed improved "parent role confidence" and "parent-baby interaction" than those with private insurance [69]. While this event was unexpected, information technology has been speculated that parents with a higher socioeconomic status and individual insurance may have higher expectations for themselves [69] and therefore may perceive an increased parental touch on on their time versus those who use Medicaid. Overall, our results suggest that greater participation in public assist programs may lessen familial and parental brunt for this patient population.

A strength of our study was our high response rate (82%). Characteristics of the infants were very similar to other follow-up programs [25]. However, we studied families of infants presenting for follow-upwardly intendance rather than the underlying population of families of infants receiving neonatal intensive care, potentially limiting generalizability. Moreover, we did sample both mothers and fathers, which may affect how some of our results are interpreted and parent gender may influence some of the measures including financial burden and social isolation [73]. Also, our study was cross-sectional making us unable to establish causation. While nosotros adjusted for a number of potential confounders, similar all observational studies, ours is subject to residual confounding. While we did non have a full term cohort command in comparing [25], nor data on those not enrolled, our aim was to elicit the feel of parents and families of preterm infants, as well as relationships with modifiable characteristics specific to this population.

Conclusions

In summary, we identified several predictors of increased family and parent impact in families of preterm infants. Of particular interest were the potentially modifiable factors including social isolation and fiscal burden, which were associated with greater touch, and use of community-based developmental services, public housing, and Medicaid which were associated with less bear upon. Our results propose that interventions to target these factors, for instance social and financial support programs, and efforts to increase enrollment in community-based developmental services and public health insurance programs, might lessen the bear upon of preterm nascency on parents and families.

Abbreviations

IOF:

Impact on family total score

ITQOL:

Babe toddler quality of life

MSD:

Motor and social evolution

NICU:

Neonatal intensive care unit

PFB:

Perceived fiscal burden

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Acknowledgments

This study was supported by the Richardson Fund, Section of Neonatology, Beth Israel Deaconess Medical Centre, Boston MA, the Program for Patient Safety and Quality (PPSQ) at Boston Children's Infirmary, Boston, MA and the Medical Staff Organization at Boston Children's Hospital, Boston, MA.

We would like to thank the families who participated in this study. We would besides like to recognize Jane Stewart, Md, the managing director of the Babe Follow Upwards Plan (IFUP) at Boston Children's Hospital, Larry Rhein, MD, the manager of the Middle for Healthy Babe Lung Development (CHILD) program at Boston Children's Hospital and Janet Soul, MD, the director of the Fetal Neurology Program at Boston Children's Hospital who facilitated our study. We would also similar thank Brooke Corder, the social worker at the IFUP who assisted with patient recruitment. We would also like to acknowledge Aaron Picklingis who developed the spider web-interface for the report questionnaire and Drs. Dionne Graham and Sheree Schrager who assisted with statistical assay.

Funding

This study was also supported by the Richardson Fund with the Section of Neonatology, Beth Israel Deaconess Medical Center, Boston MA, the Program for Patient Safety and Quality (PPSQ) at Boston Children'southward Hospital, Boston, MA and the Medical Staff Organisation at Boston Children's Hospital, Boston, MA.

Availability of data and materials

The datasets generated during and/or analyzed during the current written report are not publicly bachelor due to patient information, but are bachelor from the corresponding author on reasonable asking.

Authors' contributions

Dr. Lakshmanan and Dr. Belfort made substantial contributions to designing the study, analyzing the data, and interpreting the results. Dr. Lakshmanan wrote the start draft of the manuscript. Ms. Agni collected the data and contributed to data analysis and drafting of the manuscript. Drs. Lieu, Fleegler and McCormick made substantial contributions to designing the study, interpreting the results, and critically revising the manuscript. Drs. Kipke and Friedlich also assisted in interpreting the results and revising the manuscript. All authors read and approved the last version of the manuscript.

Consent for publication

Non applicable. At that place is no identifiable data in this study.

Competing interests

The authors declare that they have no competing interests.

Ethics approval and consent

The Boston Children'due south Hospital and Children's Infirmary Los Angeles homo subjects committees approved the study protocol and participation consent was obtained from all subjects.

Financial disclosure

Dr. Lakshmanan is supported by National Eye for Advancing Translational Scientific discipline (NCATS) of the U.South. National Institutes of Health (KL2TR001854). Dr. Belfort was supported by National Institutes of Health K23DK83817. The remaining authors have indicated they have no financial relationships relevant to this article to disclose.

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Affiliations

1. Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Children'due south Infirmary Los Angeles; Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, CA, 90027, Los Angeles, USA

   Ashwini Lakshmanan & Philippe S. Friedlich

2. Newborn and Baby Disquisitional Care Unit, Children'due south Infirmary Los Angeles, 4650 Sunset Boulevard, MS #31, CA, 90027, Los Angeles, Usa

   Ashwini Lakshmanan

3. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

   Ashwini Lakshmanan

4. Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, U.s.a.

   Ashwini Lakshmanan

5. Drexel Schoolhouse of Medicine, Philadelphia, PA, USA

   Meghana Agni

6. Division of Research, Kaiser Permanente, Oakland, CA, USA

   Tracy Lieu

7. Division of Emergency Medicine, Boston Children'south Hospital, Boston, MA, U.s.

   Eric Fleegler

8. Saban Research Constitute, Children'southward Hospital Los Angeles, Los Angeles, CA, United states

   Michele Kipke

9. Segmentation of Newborn Medicine, Boston Children's Hospital, Boston, MA, U.s.a.

   Marie C. McCormick

10. Beth State of israel Deaconess Medical Centre, Boston, MA, U.s.

    Marie C. McCormick

11. Section of Social and Behavioral Sciences, The Harvard T.H. Chan School of Public Wellness, Boston, MA, USA

    Marie C. McCormick

12. Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA

    Mandy B. Belfort

Corresponding author

Correspondence to Ashwini Lakshmanan.

Additional files

Additional file i:

Presurvey information demographics. (Doctor 108 kb)

Boosted file 2: Table S1.

Description of measurement instruments for primary outcomes, modifiable determinants and predisposing characteristics (potential confounders). (DOC 55 kb)

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Lakshmanan, A., Agni, Yard., Lieu, T. et al. The bear on of preterm birth <37 weeks on parents and families: a cantankerous-sectional study in the 2 years subsequently belch from the neonatal intensive care unit. Health Qual Life Outcomes fifteen, 38 (2017). https://doi.org/10.1186/s12955-017-0602-three

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• Received: 11 July 2016

• Accepted: 24 January 2017

• Published: 16 Feb 2017

• DOI : https://doi.org/10.1186/s12955-017-0602-3

Keywords

• Touch on on family
• Impact on parents
• Prematurity
• Loftier-risk babe
• Post-discharge

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