Volume 3 Issue 11 November, 2013
Consultation Liaison Psychiatry Focus: ‘Neonatology’
Neonatology in India is probably in the best phase ever. The state of the art Neonatal Intensive Care Units (NICU), the qualified personnel and supporting staff have made this branch of Pediatrics as exciting as ever. The challenges faced day in and day out are tremendous and are to be handled in an intelligent and delicate manner.
The increased survival of Low Birth Weight babies including Preterm, and the survivors of Neonatal Intensive Care admissions, NICU Graduates as we call, have to be followed up closely to prevent future morbidity. The Psychiatric dimension of this rapidly emerging branch has been ignored. The first and foremost role of a consultation liaison Psychiatrist in an NICU setting is to assist parents in understanding the nature and significance of each admission. The liaison psychiatrist is the infant’s voices with the families and the staff.
Like all special settings the staff in Neonatal units remain in a constant state of tension often unclear of their own responses. The distorted communication between staff and parents is often seen unless it’s coordinated. The Psychiatrist forms a perfect blend of the Profession and the Parental concerns.
Kaplan and Mason, have brilliantly described the stages of parental reactions to the birth of a sick infant.
- Anticipatory grief and depression
- Acceptance of the fact of the birth of a sick infant
- Resumption of relationship to the child
- Parents come to see infant’s special needs and come to act upon understanding.
Usually it is the second stage which is the most difficult and takes longer time but it is totally dependent on the Childs condition. The Psychiatrist plays an important role in this setting.
Caring for premature infants is very stressful undertaking. The staffs’ sense of omnipotence is constantly under threat by any unexpected deterioration in the neonate’s condition and this may affect the ability to provide optimal care. Many professionals find it difficult to cope with parental inquiries and constant reassurance seeking behavior. A false garb of confidence may provide misleading information which may be very harmful in the long run. The Psychiatrist can play a crucial role here and relieve the professionals of their anxious behavior.
The Psychiatrist can play a very helpful role in running of a neonatal unit. With the psychological aspect effectively handled, allied professionals would be able to work more efficiently. In many units the Neonatologist himself handles complex situations; however psychological care by professionally trained people is reassuring. We are likely to see more and more Liaison Psychiatrists in the Neonatal units in the near future.
Dr. Naren Sandeep D., MD Paediatrics Fellow Paediatric Intensive care (Indira Gandhi Institute of Child Health, Bangalore) Neonatal trainee (IMG, Prospective), Nepean Blue Mountains Hospital, Sydney Australia.
