Reduction of neonatal intensive care unit (NICU) parental perceptions of child vulnerability and risk of vulnerable child syndrome utilizing cognitive behavioral therapy: randomized controlled trial.

Background: Neonatal intensive care unit (NICU) parental emotional trauma can distort parental perceptions of child vulnerability (PPCV), resulting in adverse child developmental outcomes, known as Vulnerable Child Syndrome (VCS). We hypothesize utilizing a novel trauma-informed cognitive behavioral therapy (CBT) intervention will reduce PPCV in premature NICU infants' parents.

Methods: English and Spanish speaking parents of preterm infants (<31 weeks gestational age) were randomized from April 2019 to March 2020 to receive either a 5-session trauma-informed CBT intervention created for this study educating parents on PPCV concepts, or to a control group receiving standard of care. Principal outcome measure was PPCV change measured by the Vulnerable Baby Scale (VBS) scores from enrollment (33 weeks post menstrual age) to study end (6 months chronological age).

Results: 8 control and 12 intervention families completed the study (n = 42 randomized) due to COVID-19 mandatory research pause. CBT intervention group had a median VBS decrease of 6 points vs. 0 point in controls (P = 0.07). Post-hoc Bayesian analysis of VBS PPCV reduction (utilized due to limited n) favored CBT to control by 95%.

Conclusion: This is the first parental trauma-informed CBT intervention to demonstrate a PPCV decrease and lower risk of development of VCS in a high-risk NICU population.

Impact: A brief intervention shows promise in fostering improved parenting perceptions, behaviors, and outcomes. NICU parental trauma negatively impacts parental perceptions of child vulnerability and their parenting styles resulting in poor child developmental outcomes, summarized as Vulnerable Child Syndrome (VCS). Currently, there is no effective treatment standard of care to address this important clinical issue. This manuscript contributes to our understanding of the following: Trauma-informed cognitive behavioral therapy lowers parents' perceptions of vulnerability in an at-risk NICU population. This is the first published intervention to demonstrate efficacy in reducing NICU parental perceptions of child vulnerability, a key contributor to VCS. Implementation of this intervention with NICU families has the potential to reduce the risk of VCS and improve parent-child outcomes and child developmental outcomes.

Clinical trial registration: ClinicalTrials.gov identifier: NCT03906435.