A pivotal moment in the evolution of neonatal care

A study of the infant's lived experience of neonatal intensive care

BACKGROUND

Neonatal care is essential for survival. However, advancements in medical care may come at a cost to the infant's experience of living. Research has traditionally focused on the effectiveness of the medical aspects of neonatal intensive care. Less attention has been paid to the subjective experience of infants hospitalised in NICU.

AIM

To provide an infant-centred, rich understanding and comprehensive analysis of the lived experience of infants hospitalised in NICU.

METHODS

To explore the infant experience, we designed a novel approach, termed 360-degree phenomenology. We utilised observational fieldnotes, bedside diaries, Newborn Behavioural Observation recording forms and verbatim transcripts from individual interviews. Thematic analysis was used to analyse these data sources.

RESULTS

This paper uses the whole data set (comprising a series of 7 case studies) to describe 4 overarching themes: (1) scary and safe; (2) all these hard things; (3) an emotional challenge; and (4) moments of meeting.

CONCLUSION

Hospitalisation in the newborn period poses a significant challenge to the developing infant by virtue of the complex and confronting early life experiences they endure, both physically and emotionally. This research illuminates these challenges but also shows moments of powerful meeting and connection, that serve to protect and nurture the developing infant. By listening to and valuing the infant's unique perspective and placing the infant as a person central to their own care, our research highlights strategies for immediate actionable change and future areas of research to better their early life experiences and improve long-term health outcomes.

Training to increase parental participation in the care of infants in neonatal units

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of training to increase parental participation in the care of infants in neonatal units, compared to no training or a different type of training.

Barriers to Developmental Care in the NICU: An Integrative Review

BACKGROUND

Variability in developmental care implementation in the neonatal intensive care unit (NICU) highlights the need to explore barriers to care delivery, yet few studies addressed these challenges.

PURPOSE

Drawing from NICU literature, this integrative review identifies barriers to implementing developmental care with premature infants.

METHODS

A systematic search of CINAHL and PubMed (2014-2024) was conducted, yielding 2 qualitative and 5 quantitative studies.

RESULTS

Thematic analysis revealed 3 key barriers based on the theory of planned behavior: attitude, subjective norm, and perceived control.

CONCLUSIONS

To improve developmental care, a multi-pronged approach engaging stakeholders is recommended. Future research should apply rigorous implementation science methods to overcome these barriers.

Six weeks that changed the preterm infant brain: lessons learned from the Family Nurture Intervention randomized controlled trials

Aim

We review extensive results from two randomized controlled trials conducted over 9 years, comparing standard care (SC) in level-4 neonatal intensive care units (NICUs) with SC plus Family Nurture Intervention (FNI).

Methods

FNI included ~six weeks of facilitated mother-infant interactions aimed at achieving mother-infant 'autonomic emotional connection', a novel construct that describes the emotional mother-baby relationship at the level of the autonomic nervous system.

Results and conclusion

Thus far, 18 peer-reviewed publications documented significant positive short-and long-term effects of FNI on infant neurobehavioral functioning, developmental trajectories and both mother and child autonomic health through five years. The observed profound effects of FNI on central and autonomic nervous system function following a relatively short intervention support a novel autonomic theory of emotions. We discuss the theoretical and clinical advances that grew out of the trials and speculate on how FNI changes the mother-infant relationship from 'dysregulation' to autonomic emotional co-regulation. We review new constructs and tools that can be used to view and measure the mother-infant autonomic emotional relationship. We present a simple blueprint to improve preterm birth outcomes. Finally, we discuss the significance of our findings and possible impact on the future of preterm infant care worldwide.

A Longitudinal Qualitative Study of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy

PURPOSE

To understand how barriers and facilitators interact over time to support or disrupt breastfeeding among women on opioid maintenance therapy for opioid use disorder.

BACKGROUND

Breastfeeding has additional benefits for newborns with prenatal opioid exposure. Up to 80% of women on opioid maintenance therapy plan to breastfeed, but many do not beyond the first 7 to 10 days.

METHODS

A qualitative, longitudinal design was used. Semi-structured interviews occurred during the third trimester of pregnancy and again between 1 and 6 weeks postpartum. Thematic analysis was conducted using the Breastfeeding in a Life Course Context model as a framework. The design and methods were informed by a post-positivist, critical realist perspective.

RESULTS

Thirteen participants were enrolled, and 19 interviews were completed. Five themes were identified. It Will Work Out was the primary theme that describes participants' sense of self-efficacy, stemming from their experiences of managing addiction recovery. Women considered breastfeeding to support their own health and that of their newborn while in recovery, summarized by Being Healthy. Making the choice to breastfeed, represented by Weighing the Options, was influenced by their perinatal health care providers. During the Sensitive Period, challenges could overwhelm their self-efficacy. Of 9 women, 4 were still breastfeeding when interviewed postpartum, exemplified by Moving On.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Participants' self-efficacy and motivation to be healthy played a significant role in managing breastfeeding challenges over time. Nursing interventions must empower women's self-efficacy to help them achieve their breastfeeding goals.

A unit's experience with hybrid NICU design: description of care model and implications for patients, families, and professionals

As the first extra-uterine setting for hospitalized infants, the neonatal intensive care unit (NICU) environment can make a lasting impact on their long-term neurodevelopment. This impact is likely mediated through both specific characteristics of the physical design of the care environment, as well as the experiences that occur within this environment. Recent studies document many established benefits of single-family rooms (SFRs). However, there is concern that infants who spend a prolonged time in SFRs without their parents being intimately involved in their care have reduced opportunities for meaningful experiences, with possible adverse consequences. The purpose of this report is to share an example of an application of the family-centered developmental care model through a hybrid NICU design, inclusive of both SFRs and semi-private bays. In this paper, we empirically describe the physical and operational considerations of a hybrid model, outline the strengths and challenges of this approach, and discuss implications for patients, families, and professionals.

Mother-newborn couplet care: Nordic country experiences of organization, models and practice

Mother-Newborn Couplet Care is a concept and is defined as the provision of care for a sick or preterm newborn in close proximity to and coupled with the care for the mother from the birth of the infant and for as long as the mother needs hospital care. This concept of care requires system change in both obstetrics and pediatrics in terms of the planning and organization of care, equipment and design of units. Accordingly, strong leadership setting clear goals and emphasizing a culture of cohesive care, supported by targeted education and training is crucial to ensure high-quality care of all mother-newborn dyads without separation. We describe various organizational models of Mother-Newborn Couplet Care used in Sweden and Finland and implementation processes. We envision a future where newborns and mothers are always together, irrespective of medical needs, and form an inseparable center around which healthcare services and providers are organized.