A preterm lifeline: Early discharge programme based on family-centred care

Observational study showed that using video consultations was a viable way of delivering an early discharge programme for preterm infants

AIM

The aim of this study is to evaluate an early discharge programme with video consultations for preterm infants.

METHODS

A homecare programme for preterm infants was developed. Prospective data on readmissions, length of stay, growth, breastfeeding rates, and parent self-reports about satisfaction were collected from April 2021 to August 2023. Additionally, retrospective data were collected from the Norwegian Neonatal Network Central Database from 2020.

RESULTS

Preterm infants, 72 and parents, 128 were included. The infants were discharged from the hospital at a median of 35 + 6 (34 + 0-42 + 4) weeks postmenstrual age. The median length of stay in the program was 18 days (3-37). There were four readmissions. The Z-score of infant weight slightly increased during the follow up, with a mean of 0.16. By discharge, 75% of the infants were exclusively breastfed. Growth and breastfeeding rates were in line with retrospective data (85 infants). The response rate of the parents to the survey was 61 (52%). Overall, the parents (n = 54) were highly satisfied (96%). The video consultations contributed to ensuring parents to feel safe in caring for their infant at home.

CONCLUSION

Follow up by video consultations is a viable healthcare service for preterm infants, the infants' growth is sufficient, breastfeeding rates are maintained, and parents feel safe and satisfied.

What matters to families about the healthcare of preterm or low birth weight infants: A qualitative evidence synthesis

OBJECTIVE

We examined what matters to families about the healthcare provided to preterm or LBW infants in hospital and the community, to ensure that care meets the needs of infants and parents.

METHODS

We searched databases to identify eligible studies examining the views and expectations of families. Study quality was assessed using the CASP checklist for qualitative studies. The GRADE-CERQual approach was used to assess confidence in review findings. Studies were sampled and data analysed using thematic synthesis.

RESULTS

222 studies (227 papers) were eligible for inclusion. 54 studies (57 papers) were sampled based on data richness, methodological quality, and representation across settings. Eight analytical themes were identified. Confidence in results was moderate to high. What mattered was a positive outcome for the child; active involvement in care; being supported to cope at home after discharge; emotional support; the healthcare environment; information needs met; logistical support available; and positive relationships with staff.

CONCLUSION

Although parents and family members reported a variety of experiences in the care of their infant, we found high consistency in what matters to families.

PRACTICE IMPLICATIONS

This review identifies approaches to improve experiences of parents which are consistent with the Family Centred Care model of healthcare.

Perception and Educational Needs of Developmentally Supportive Care At-Home for Parents of Pre-Term Newborns

After discharge from neonatal intensive care units (NICUs), the parents of pre-term newborns have to provide developmentally supportive care (DSC) to their children; thus, educational support for parents is essential. This study aimed to explore the lived experiences of parents providing DSC to their children born as pre-term newborns at home and to investigate their parenting-related needs. This study included 10 mothers who were identified through theoretical sampling. In-depth interviews were conducted for data collection. For data analysis, grounded theory was used according to Corbin and Strauss's process. The mother's perception and educational needs were characterized by the phenomena "Coexistence of familiarity and unfamiliarity" and "Desire for expert support". Causal conditions include the "Incomplete education system" and "Gap between expectations and reality". Contextual conditions include the "Fear of developmental disability" and "Lack of good evaluation criteria". Intervening conditions include the "Difficulty in obtaining useful information". Action/interaction strategies include the "Active information seeking" and "Continuing to provide DSC". The consequences were the "Needs for professional educational support". The core category was the "Parenting routine that continues without awareness" and "Hope to establish parenting system supported by multidisciplinary experts". These results may provide the preliminary evidence base for suitable educational programs and for developing a social support system for parents.

From Expressing Human Milk to Breastfeeding-An Essential Element in the Journey to Motherhood of Mothers of Prematurely Born Infants

BACKGROUND

Lactation and breastfeeding present an extraordinary challenge for mothers of prematurely born infants.

PURPOSE

To explore the significance of and the circumstances that affect lactation for mothers of premature infants.

METHODS

A qualitative exploratory study based on single, in-depth, semistructured interviews with 16 purposefully sampled mothers of premature infants admitted to the neonatal intensive care unit (NICU). Data were analyzed using content analysis. The study was reported according to Standards for Reporting Qualitative Research.

FINDINGS

The overall theme was "From expressing human milk to breastfeeding-an essential element in the journey to motherhood." The theme emerged from 3 categories: the birth preparation time has been interrupted; expressing human milk is essential for lactation; and the motherhood journey encompasses breastfeeding. The analysis also revealed that the categories were impacted by initiating, performing, and maintaining lactation and further influenced by inhibitors and promoters.

IMPLICATIONS FOR PRACTICE

The promoters for performing milk expression and breastfeeding should be stimulated and the inhibitors should be eliminated. The achievement of "zero separation" and mother-infant couplet care in the NICU would be beneficial. In order for mothers to maintain successful lactation, it is essential that they receive supportive around-the-clock access to health professionals with expertise in lactation and breastfeeding until exclusive breastfeeding is well established.

IMPLICATIONS FOR RESEARCH

The study highlights the need to investigate mother-infant as one entity rather than separately as mother and infant.

Mobilizing Forward: An Interpretive Description of Supporting Successful Neonatal Intensive Care Unit-To-Home Transitions for Adolescent Parents

Pregnancy and parenting in adolescence and the transition home following the hospitalization of an infant in the neonatal intensive care unit (NICU) are two relatively complex phenomena; and whilst each have been consistently explored within the relevant literature, little is understood about the care required when they intersect. Using interpretive description methodology to guide our exploration, we conducted semi-structured interviews with 23 expert providers caring for adolescent parents involved in NICU-to-home transitions to describe this process in their practice. Findings suggest that supporting successful NICU-to-home transitions for adolescent parents relied strongly on understanding the impact of the NICU experience, establishing therapeutic relationships and facilitating supportive partnerships between the NICU and parents as well as the NICU and supportive services post-discharge. Findings highlight the opportunity for more integrated models of care within the NICU and extending into the community to address the complex biopsychosocial care needs of this parent population.

Knowledge of mothers and fathers' experiences of the early in-home care of premature infants supported by video consultations with a neonatal nurse

Aim

To gain in-depth knowledge of mothers’ and fathers’ experiences of the whole trajectory of an early in-home care programme supported by video consultations with a neonatal nurse.

Design

A qualitative interview study.

Methods

Data were collected through dyadic semi-structured interviews with mothers and fathers participating in virtual early in-home care programmes and were subjected to inductive content analysis.

Findings

The mothers and fathers were anxious about mastering the care of their premature infants at the start of the early in-home care phase but gradually developed confidence by the completion of the early in-home care programme. Being at home during the early in-home care programme gave the mothers and fathers an opportunity to test their decision making concerning the care of the infant while having the ability to obtain support from nurses when needed.

Conclusion

Our findings indicate that the trajectory of early in-home care programmes combined with video consultations contributes to parents’ increased confidence as mothers and fathers.

Trial registration

Clinical trial registration: REG-113-2014 and SJ-431.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00572-9.

Video consultation as nursing practice during early in-home care for premature infants and families viewed from the families' homes'

AIM

This study examined how communication between nurses and families in video consultations in a neonatal early in-home care program unfolded in the context of parents' homes.

DESIGN

A qualitative study based on focused observations supported by audio-recorded video consultations.

METHODS

The data were collected through nine video consultations between nurses and families in an early in-home care program. The transcribed material was examined using inductive content analysis.

FINDINGS

The analyses revealed the following themes: "Setting the scene," "Weight as a point of reference" and "The pros and cons of technology." The video consultations unfolded in a relaxed atmosphere, but also as one-way communication dominated by nurses, with the infant's weight as the focus. The study finds that a focus on training in video communication is needed to take full advantage of video consultations' potential.

Association between neonatal homecare for preterm infants and incidence of severe postpartum depression in mothers

BACKGROUND

Understanding the association between neonatal homecare and postpartum depression could contribute to the design of evidence-based interventions to prevent postpartum depression. We aimed to determine whether the change from inpatient stays in neonatal intensive care units to offering neonatal homecare was associated with a reduced incidence rate of severe postpartum depression among mothers who gave birth prematurely.

METHODS

We conducted a register-based population-wide study of all mothers who gave birth prematurely 1994-2017 to live-born infants and spent at least one night in the Neonatal Intensive Care Unit. We performed an interrupted time series analysis to investigate the incidence rate ratio of severe postpartum depression before and after the implementation of neonatal homecare. Neonatal homecare was implemented between 1994 and 2016.

RESULTS

The total population consisted of 46,456 mothers and the median age was 30 years and interquartile range of 27-34 years. Overall 4.5 % of the mothers were diagnosed with severe postpartum depression. Prior to neonatal homecare no change in the incidence of severe postpartum depression was found; (incidence rate ratio=1.01 [95 % confidence interval: 0.97-1.05] every half year, p=0.69). The implementation was associated with a level change with an incidence rate ratio reduction of 23 % (incidence rate ratio=0.77 [95 % confidence interval: 0.64-0.93], p=0.007).

LIMITATIONS

Limitations include potential underdiagnosis in early periods, lack of randomization, and different periods of implementation of neonatal homecare.

CONCLUSIONS

We found a possible association between the implementation of neonatal homecare and a 23 % reduced incidence rate of severe postpartum depression among mothers of preterm infants.

The Complexity of the NICU-to-Home Experience for Adolescent Mothers: Meleis' Transitions Theory Applied

Quality care for individuals and families during periods of transition is one of the major issues facing health care systems and providers today. The transition-home from the neonatal intensive care unit (NICU) as experienced by adolescent mothers is poorly understood-placing young mothers and their infants at risk of poor outcomes following NICU discharge. Meleis' Transitions Theory offers a unique theoretical perspective for understanding this transition experience and also serves to highlight the complexity of the NICU-to-home transition for this population of young mothers that is not currently elucidated in the literature.

Comparison of video and in-hospital consultations during early in-home care for premature infants and their families: A randomised trial

Introduction

Early in-home care is increasingly being used in Scandinavian countries for clinically stable premature infants. Due to challenges with travel and hospital resources, alternative ways to support parents during early in-home care are being considered. The aim of this study was to test whether the proportion of mothers exclusively breastfeeding, parental confidence and mother–infant interaction increased after early in-home care with premature infants, and to compare the outcomes of in-home care involving the use of video communication and a mobile application with those of in-home care involving in-hospital consultations.

Methods

This study was conducted in four neonatal wards offering premature infant in-home care in Denmark. Premature infants were randomised using 1:1 block randomisation. During early in-home care, families had planned consultations two to three times a week, during which they received support from nurses: the intervention group had video consultations, while the control group had in-hospital consultations.

Results

The proportion of exclusively breastfeeding mothers at discharge was 66.7% in the intervention group vs 66% in the control group and decreased to 49.4% vs 55%, respectively, 1 month after discharge. No significant improvements were found in the intervention group compared with the control group. In the intervention group, some video consultations were changed to telephone consultations due to problems with the video function, or to in-hospital consultations due to infants’ requirement for medical services. No significant differences in secondary outcomes were observed.

Discussion

The study showed similar breastfeeding proportions at discharge. No unfavourable effects of video consultation compared with in-hospital consultation were found, indicating that video consultation could be a viable option and an important supplement during early in-home care.

Trial registration

ClinicalTrials.gov ID: NCT02581800.

Adding value to core outcome set development using multimethod systematic reviews

Trials evaluating the same interventions rarely measure or report identical outcomes. This limits the possibility of aggregating effect sizes across studies to generate high-quality evidence through systematic reviews and meta-analyses. To address this problem, core outcome sets (COS) establish agreed sets of outcomes to be used in all future trials. When developing COS, potential outcome domains are identified by systematically reviewing the outcomes of trials, and increasingly, through primary qualitative research exploring the experiences of key stakeholders, with relevant outcome domains subsequently determined through transdisciplinary consensus development. However, the primary qualitative component can be time consuming with unclear impact. We aimed to examine the potential added value of a qualitative systematic review alongside a quantitative systematic review of trial outcomes to inform COS development in neonatal care using case analysis methods. We compared the methods and findings of a scoping review of neonatal trial outcomes and a scoping review of qualitative research on parents', patients', and professional caregivers' perspectives of neonatal care. Together, these identified a wider range and greater depth of health and social outcome domains, some unique to each review, which were incorporated into the subsequent Delphi process and informed the final set of core outcome domains. Qualitative scoping reviews of participant perspectives research, used in conjunction with quantitative scoping reviews of trials, could identify more outcome domains for consideration and could provide greater depth of understanding to inform stakeholder group discussion in COS development. This is an innovation in the application of research synthesis methods.

Parents' perceptions of core outcomes in neonatal research in two Nigerian neonatal units

BACKGROUND

There is a scarcity of information regarding the most important outcomes for research in neonatal units in low-resource settings. Identification of important outcomes by different stakeholder groups would inform the development of a core outcome set (COS) for use in neonatal research.

OBJECTIVE

To determine the perceptions and opinions of parents of newborn babies regarding what outcomes were most important to them in order to contribute towards development of a COS for neonatal research in sub-Saharan Africa.

METHODS

Semistructured interviews were undertaken with parents, mostly mothers, of babies admitted to one neonatal unit in North central and one in Southwest Nigeria. Participants were purposively sampled to include parents of babies with common neonatal problems such as prematurity.

RESULTS

We conducted 31 interviews. The most frequently raised outcomes were breast feeding, good health outcomes for their baby, education, growth and financial cost. Parents placed more emphasis on quality of life and functional status than health complications.

CONCLUSIONS

The opinions of parents need to be considered in developing a COS for neonatal research in low-resource settings. Further research should assess the opinions of families in other low-resource settings and also engage a broader range of stakeholders.

Supporting families on their journey towards a normal everyday life - facilitating partnership in an early discharge program for families with premature infants

PURPOSE

Several Danish neonatal intensive care units (NICUs) offer the possibility of an early discharge program (EDP) for families with premature infants, when the infant reaches the gestational age ≥ 34 weeks and a weight ≥ 1,500 g. The purpose of this study is to explore how the partnership with these families can be facilitated by the nurse based on the principles of the framework of family centered care (FCC).

DESIGN AND METHODS

The study was conducted as an ethnographic inquiry inspired by Spradley and based on participant observation of 12 contacts between nurse and family, one informal and three formal interviews with nurses in the EDP-unit of a Danish NICU.

RESULTS

This study illustrates how EDP-nurses facilitate a partnership with the families enrolled in EDP by using a range of complex strategies to adjust their care to the family's changing needs, while acknowledging the family's way of being. The partnership typically develops in three phases: "Settling in EDP," "Thriving in EDP," and "Leaving the EDP nest." The EDP-nurses have a clear understanding of whether a partnership is well functioning or challenging and they play a unique role by facilitating a partnership that supports the family on the journey towards a normal everyday life.

PRACTICE IMPLICATIONS

The knowledge unraveled in this study may prove helpful for training future EDP-nurses in the neonatal field of FCC, when improving the quality of an existing EDP or developing a new EDP based on the principles of FCC.

Stress experienced by mothers of preterm newborns in a neonatal intensive care unit

OBJECTIVE

To evaluate the stress level of mothers of preterm infants with gestational age ≤34 weeks, hospitalized in neonatal intensive care.

METHOD

A cross-sectional study with 74 mothers of premature infants in neonatal intensive care, who answered the "Parental Stress Scale: Neonatal Intensive Care Unit" instrument, validated in Brazil.

RESULTS

The mean stress level was 4.41 (± 0.77) and the general stress level was 4.36 (± 0.76), with a significant difference (p <0.001) between the subscale "Alteration in parental roles" and other subscales, meaning that mothers were in a very stressful situation.

CONCLUSION

All items in the subscale "Alteration in parental roles" of the "Parental Stress Scale: Neonatal Intensive Care Unit" were identified as the main source of stress experienced by mothers. This study suggests carrying out further studies with other methodologies to increase the knowledge of maternal stress in the national context, applying care interventions involving the parents.

Cost analysis of neonatal tele-homecare for preterm infants compared to hospital-based care

Introduction

Neonatal homecare (NH) can be used to provide parents the opportunity of bringing cardiopulmonary-stable preterm infants home for tube feeding and the establishment of breastfeeding supported by neonatal nurses visiting the home. However, home visits can be challenging for hospitals covering large regions, and, therefore, regular neonatal hospital care has remained the first choice in Denmark. As an alternative to home visits, telehealth may be used to deliver NH. Thus, neonatal tele-homecare (NTH) was developed. Positive infant outcomes and the optimization of family-centred care have been described, but the costs of telehealth in the context of NH remain unknown. This study aims to assess the costs of NTH compared to regular neonatal hospital care, from the health service perspective.

Methods

The cost analysis was based on an observational study of NTH in Denmark (run from November 2015 to December 2016) and followed the Consolidated Health Economic Evaluation Reporting Standards. The intervention group were the families of preterm infants receiving NTH ( n = 96). The control group comprised a historic cohort of families with preterm infants, receiving standard care in the neonatal intensive care unit (NICU) ( n = 278). NTH infants and the historical group were categorized according to gestational age at birth at/under and over 32 weeks. The outcomes were NTH resource utilization, in-NICU hospital bed days, re-admissions and total costs on average per infant. The time horizon was from birth to discharge.

Results

The costs of NTH resource utilization were, on average, €695 per infant, and the total costs per infant, on average, were €12,200 and €4200 for infants at/under and over 32 weeks, respectively. The corresponding costs of the control group were €14,300 and €4400. The difference in total costs showed statistical significance for the group of infants under 32 weeks ( p < 0.001).

Discussion

The cost analysis showed that NTH was less costly compared to regular hospital care, especially for infants born with gestational age at/under 32 weeks. NTH is an appropriate model of care for preterm infants and their families, is clinically effective and less expensive than similar services delivered in the hospital.

Growth and breastfeeding of preterm infants receiving neonatal tele-homecare compared to hospital-based care

OBJECTIVE

Neonatal tele-homecare implies that parents of clinically stable preterm infants can manage tube feeding and establishment of oral feeding in the home. Support is provided from the neonatal intensive care unit (NICU) through a telehealth service. The aim of this study was to compare growth and breastfeeding rates amongst infants being managed in the NICU (conventional care) and by neonatal tele-homecare.

METHODS

A total of 96 preterm infants with tube feeding requirements participated in the observational study of neonatal tele-homecare. Retrospective data in 278 preterm infants receiving standard care in the same neonatal intensive care unit prior to implementation of neonatal tele-homecare were used for comparison. Rates of breastfeeding and growth were monitored during neonatal tele-homecare. Infant weights were converted to standard deviation weight-for-age z-scores based on a reference.

RESULTS

There was no significant difference in rates of exclusive breastfeeding between the neonatal tele-homecare infants and the controls. Among the very preterm singleton infants more neonatal tele-homecare infants were exclusively breastfed at discharge compared to the controls (p = 0.04). There was no significant difference in median weight for age z-scores at discharge.

CONCLUSION

This study demonstrates that neonatal tele-homecare may be an appropriate model of care for the management of preterm infants outside of the hospital environment; with the added benefit of higher rates of breastfeeding at time of discharge for very preterm infants.

Understanding the Effects of Neonatal Early Discharge on Parents: A Literature Review

A neonatal early discharge (NED) program is a supported process where preterm infants leave hospital before they have established full sucking feeds and are gavage fed by their parents while they transition to breast- and/or bottle-feeds. While there is some evidence in the literature describing the outcomes of this process for preterm infants, there is even more limited evidence of the effects and outcomes of these NED programs on parents. The objective of this study was to summarize and critically appraise the literature regarding the effects of NED on parents. A literature search was conducted for English language publications since 2007 using MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar. A total of 20 primary articles met the inclusion criteria for the review. An integrative thematic synthesis identified 4 themes: establishing parenting skills/confidence; bonding with the newborn; psychological distress; and the need for support and resources. Findings suggest that parents have various concerns regarding discharge from the neonatal unit and therefore support from healthcare professionals and family plays a crucial role during the experience. There were also various external factors such as socioeconomic status and cultural differences that impact on parents differently, and it is therefore challenging to draw definite conclusions. This warrants further research in the area.

Parent perspectives of neonatal tele-homecare: A qualitative study

INTRODUCTION

Neonatal homecare for preterm infants is a method of supporting families and monitoring infant growth in the home setting. Telehealth may be used to deliver specialist neonatal care remotely, using online communication methods. This study explored parental experiences with neonatal tele-homecare (NTH).

METHODS

Semi-structured interviews were conducted with 49 parents whose preterm infants had received NTH from a neonatal intensive care unit (NICU) in Denmark. Interview transcripts were analysed using Malterud's systematic text condensation.

RESULTS

Parents experienced NTH as a personalised method for linking to specialist staff in the NICU. NTH promoted the parent's role as the primary care provider, further strengthening the parent-infant relationship.

DISCUSSION

From the perspective of parents with preterm infants requiring specialist care, NTH is a useful method of supporting families in the home. Telehealth provides effective communication links with NICU specialists and encourages family-centred care.

ABM Clinical Protocol #12: Transitioning the Breastfeeding Preterm Infant from the Neonatal Intensive Care Unit to Home, Revised 2018

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols, free from commercial interest or influence, for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Parent, patient and clinician perceptions of outcomes during and following neonatal care: a systematic review of qualitative research

OBJECTIVE

Multiple outcomes can be measured in infants that receive neonatal care. It is unknown whether outcomes of importance to parents and patients differ from those of health professionals. Our objective was to systematically map neonatal care outcomes discussed in qualitative research by patients, parents and healthcare professionals and test whether the frequency with which outcomes are discussed differs between groups.

DESIGN

Systematic review of qualitative literature. The following databases were searched: Medline, CINAHL, EMBASE, PsycINFO and ASSIA from 1997 to 2017. Publications describing qualitative data relating to neonatal care outcomes, reported by former patients, parents or healthcare professionals, were included. Narrative text was analysed and outcomes grouped thematically by organ system. Permutation testing was applied to assess an association between the outcomes identified and stakeholder group.

RESULTS

Sixty-two papers containing the views of over 4100 stakeholders were identified; 146 discrete outcomes were discussed; 58 outcomes related to organ systems and 88 to other more global domains. Permutation testing provides evidence that parents, former patients and health professionals reported outcomes with different frequencies (p=0.037).

CONCLUSIONS

Parents, patients and health professionals focus on different outcomes when discussing their experience of neonatal care. A wide range of neonatal care outcomes are reported in qualitative research; many are global outcomes relating to the overall status of the infant. The views of former patients and parents should be taken into consideration when designing research; the development of a core outcomes set for neonatal research will facilitate this.

Participatory design methods for the development of a clinical telehealth service for neonatal homecare

Objectives:

Neonatal homecare delivered during home visits by neonatal nurses is a common method for supporting families of preterm infants following discharge. Telehealth has been introduced for the provision of neonatal homecare, resulting in positive feedback from parents of preterm infants. While the benefits are beginning to be realised, widespread uptake of telehealth has been limited due to a range of logistical challenges. Understanding user requirements is important when planning and developing a clinical telehealth service. We therefore used participatory design to develop a clinical telehealth service for neonatal homecare.

Methods:

The study adopted a participatory design approach to engage users in the development and design of a new telehealth service. Participatory design embraces qualitative research methods. Creative and technical workshops were conducted as part of the study. Tests of the telehealth service were conducted in the neonatal unit. Participants in this study were former and current parents of preterm infants eligible for neonatal homecare, and clinical staff (medical and nursing) from the neonatal unit. Preterm infants accompanied their parents.

Results:

Based on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information regarding infant growth and well-being.

Conclusion:

Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design of a new telehealth service for neonatal homecare based on the needs of parents and clinical staff.

Rallying the Troops: How Sharing Knowledge With Grandparents Supports the Family of the Preterm Infant in Neonatal Intensive Care Unit

BACKGROUND

Research concludes that there is a need for educational programs for grandmothers, as well as networking opportunities; educational programs for other extended family members have long been sought by parents, relatives, and nurses in neonatal intensive care unit.

PURPOSE

To describe the effect of having premature infants' extended families participating in family-centered care (FCC) groups in the neonatal intensive care unit. An intervention based on dialogue, including topics as own reactions, general knowledge about the premature infants, parenthood, and how the extended families can support the new families during hospitalization and after discharge.

METHODS

A qualitative content analysis of 2 focus group interviews involving 16 purposefully sampled extended family members, who had participated in 1½ hours of FCC group interventions.

FINDINGS

The overall theme was: Accepting the individuality of the infant and providing the family with realistic expectations for the future. This theme emerged during the analysis of 4 categories: knowledge sharing, same basis for understanding, access to the immediate family, and competent supporting role. The interrelationship between the categories also emerged, surprisingly, during the analysis.

IMPLICATIONS FOR PRACTICE

Extended family members should be recognized as an essential part of the new family's life from the time of the premature infant's admission to neonatal intensive care unit. Family-centered care group interventions should be integrated into ward practice and policy.

IMPLICATIONS FOR RESEARCH

The study reinforces the need for further research, utilizing both qualitative and quantitative methods, into age and ethnicity aspects of FCC group interventions. There is also a need to compare the new parents' perceived level of stress and support from the FCC group intervention in relation to participating and nonparticipating extended families.

Multicentre randomised study of the effect and experience of an early inhome programme (PreHomeCare) for preterm infants using video consultation and smartphone applications compared with inhospital consultations: protocol of the PreHomeCare study

INTRODUCTION

Although premature infants and their parents are discharged earlier to inhomecare programmes, how to optimally support parents during this transition remains unknown. The aim of this study is to compare the effects of early inhomecare (PreHomeCare) including video consultations and mobile applications with those of inhospital consultations regarding breast feeding, parental confidence and parent-infant interactions.

METHODS AND ANALYSIS

A randomised controlled intervention study will be conducted in four neonatal departments offering PreHomeCare (ie, premature infant inhomecare) in Denmark. Parents of hospitalised premature infants who fulfil the inclusion criteria for PreHomeCare will be randomised during hospitalisation to either the intervention (n=80) or control group (n=80) using 1:1 block randomisation. During PreHomeCare, the intervention group will receive a smartphone application with a video system and an infant scale, and the control group will receive usual care (ie, hospital consultations). Additionally, both groups will have planned nurse consultations two to three times a week: the intervention group through video consultations and the control group through inhospital consultations. Data collection will occur at inclusion/baseline, at the end of PreHomeCare and 1 month after discharge using questionnaires and hospital records. The primary outcome is the proportion of exclusively breastfed infants 1 month after discharge/end of PreHomeCare, the secondary outcomes are parent-infant interactions measured by the Mother and baby interaction scale and family confidence in caring for infants measured by the Karitane Parenting Confidence Scale. The process evaluation will consist of two qualitative studies: a field study and an interview study. Data collection will initially involve field observations of three scheduled video consultations with six families from the intervention group. These families will also be interviewed 1 month after PreHomeCare has ended.

ETHICS AND DISSEMINATION

The project has been approved by the Regional Ethics Committee and the Danish Data Protection Agency.

TRIAL REGISTRATION NUMBER

NCT02581800.

Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design

Background

For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored.

Objective

To identify parental needs when wanting to provide neonatal home care supported by telemedicine.

Methods

The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively.

Results

Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a “bell cord” to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition.

Conclusions

Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using telemedicine.