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Johnson JO. Implementation of Family Centered Care for Neonates Admitted in a Special Care Baby Unit in Sierra Leone. Pediatric Health Med Ther 2024; 15:189-199. [PMID: 38774023 PMCID: PMC11107938 DOI: 10.2147/phmt.s455804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/09/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose To assess the feasibility of implementing family centered care and the impact this would have on parental satisfaction in a special care baby unit in Sierra Leone. Patients and Methods A cross-sectional, mixed methods study was conducted at the Rokupa Government Hospital, Sierra Leone. 16 nursing staff of the Special Care Baby Unit and 7 caregivers of neonates admitted in the unit participated in the study. Quantitative data on feasibility was obtained from nursing staff using a five-point Likert scale administered to staff before and after implementation of family centered care in the unit. Qualitative data on perception of impact was obtained through focus group discussions for caregivers whose neonates had received family centered care and a control group who had received standard unit care. Quantitative data was analyzed using univariate analysis and thematic analysis was undertaken for qualitative data. Results Before implementation, most nursing staff felt implementation of family centred care was not feasible (87.5%) and more than half of nursing staff either strongly agreed or agreed with each of the negative statements regarding the practice of family centred care indicating a generally negative perception. After implementation there was improvement in nursing staff perception of family centred care, however the majority still doubted the continued feasibility of this practice (68.8%). Qualitative discussions with caregivers demonstrated that caregivers whose babies received family centered care were less distressed and more satisfied during the period of admission than those who received routine care. Conclusion Family centered care improved the experiences of caregivers in the unit. Nursing staff also demonstrated a better understanding of the benefits of family centered care after it was implemented. Concerns regarding understaffing and the unit being too small to accommodate caregivers and staff at the same time need to be addressed. There is need to integrate family centered care into hospital policy.
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Affiliation(s)
- Jedidah Olayinka Johnson
- Department of Pediatrics, University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
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Tiryaki Ö, Çınar N, Caner İ. The effect of family integrated care on preparing parents with premature infants hospitalized in the neonatal intensive care unit for discharge. J Perinatol 2024:10.1038/s41372-024-01931-5. [PMID: 38499753 DOI: 10.1038/s41372-024-01931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE The study was designed as a randomized controlled experimental trial to determine the effect of the Family Integrated Care (FICare) model on the readiness of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) for discharge and home care of the infants. STUDY DESIGN Parents in the intervention group received FICare, and parents in the control group received standard care. RESULTS The total mean score of the mothers and fathers in the intervention group regarding readiness for discharge and home care was higher than that of the control group, and a significant difference was observed. A statistically significant difference was found in terms of discharge weight, the day of first enteral feeding, and first breast milk. CONCLUSION The FICare model was observed to enhance the readiness of mothers and fathers for discharge and home care and positively affect the infant's weight gain, the status of breastfeeding and the continuation of nutrition. CLINICAL TRIAL REGISTRATION Registered on ClinicalTrials.gov (Identifiers: NCT04478162 Unique Protocol ID: 16214662/050.01.04/14) on 17/07/2020.
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Affiliation(s)
- Öznur Tiryaki
- Department of Midwifery, Faculty of Health Science, Sakarya University, Sakarya, Turkey.
| | - Nursan Çınar
- Department of Pediatric Nursing, Faculty of Health Science, Sakarya University, Sakarya, Turkey
| | - İbrahim Caner
- Faculty of Medicine, Division of Neonatology, Department of Pediatrics, Sakarya University, Sakarya, Turkey
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Kabajassi O, Reiter A, Tagoola A, Kenya-Mugisha N, O'Brien K, Wiens MO, Feeley N, Duby J. Facilitators and constraints to family integrated care in low-resource settings informed the adaptation in Uganda. Acta Paediatr 2024. [PMID: 38411347 DOI: 10.1111/apa.17182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
AIM Family Integrated Care (FICare) was developed in high-income countries and has not been tested in resource-poor settings. We aimed to identify the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda. METHODS Maternal focus groups and healthcare provider interviews were conducted at Uganda's Jinja Regional Referral Hospital in 2020. Transcripts were analysed using inductive content analysis. An adaptation team developed Uganda FICare based on the identified facilitators and constraints. RESULTS Participants included 10 mothers (median age 28 years) and eight healthcare providers (seven female, median age 41 years). Reducing healthcare provider workload, improving neonatal outcomes and empowering mothers were identified as facilitators. Maternal stress, maternal difficulties in learning new skills and mistrust of mothers by healthcare providers were cited as constraints. Uganda FICare focused on task-shifting important but neglected patient care tasks from healthcare providers to mothers. Healthcare providers learned how to respond to maternal concerns. Intervention material was adapted to prioritise images over text. Mothers familiar with FICare provided peer-to-peer support to other mothers. CONCLUSION Uganda FICare shares the core values of FICare but was adapted to be feasible in low-resource settings.
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Affiliation(s)
| | - Anna Reiter
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | | | | | - Karel O'Brien
- Department of Paediatrics, Sinai Health System, Toronto, Ontario, Canada
| | - Matthew O Wiens
- Walimu, Kampala, Uganda
- Centre for International Child Health, BC Children's & Women's Hospital, Vancouver, British Columbia, Canada
| | - Nancy Feeley
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
- Centre for Nursing Research, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
| | - Jessica Duby
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
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Tomlinson C, Haiek LN. Breastfeeding and human milk in the NICU: From birth to discharge. Paediatr Child Health 2023; 28:510-526. [PMID: 38638537 PMCID: PMC11022875 DOI: 10.1093/pch/pxad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/20/2022] [Indexed: 04/20/2024] Open
Abstract
It is well recognized that human milk is the optimal nutritive source for all infants, including those requiring intensive care. This statement reviews evidence supporting the importance of breastfeeding and human milk for infants, and why breastfeeding practices should be prioritized in the neonatal intensive care unit (NICU). It also reviews how to optimally feed infants based on their stability and maturity, and how to support mothers to establish and maintain milk production when their infants are unable to feed at the breast.
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Affiliation(s)
- Christopher Tomlinson
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
| | - Laura N Haiek
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
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Hoeben H, Alferink MT, van Kempen AAMW, van Goudoever JB, van Veenendaal NR, van der Schoor SRD. Collaborating to Improve Neonatal Care: ParentAl Participation on the NEonatal Ward-Study Protocol of the neoPARTNER Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1482. [PMID: 37761442 PMCID: PMC10527908 DOI: 10.3390/children10091482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
Parents are often appointed a passive role in the care for their hospitalised child. In the family-integrated care (FICare) model, parental involvement in neonatal care is emulated. Parental participation in medical rounds, or family-centred rounds (FCR), forms a key element. A paucity remains of randomised trials assessing the outcomes of FCR (embedded in FICare) in families and neonates, and outcomes on an organisational level are relatively unexplored. Likewise, biological mechanisms through which a potential effect may be exerted are lacking robust evidence. Ten level two Dutch neonatal wards are involved in this stepped-wedge cluster-randomised trial FCR (embedded in FICare) by one common implementation strategy. Parents of infants hospitalised for at least 7 days are eligible for inclusion. The primary outcome is parental stress (PSS:NICU) at discharge. Secondary outcomes include parental, neonatal, healthcare professional and organisational outcomes. Biomarkers of stress will be analysed in parent-infant dyads. With a practical approach and broad outcome set, this study aims to obtain evidence on the possible (mechanistic) effect of FCR (as part of FICare) on parents, infants, healthcare professionals and organisations. The practical approach provides (experiences of) FICare material adjusted to the Dutch setting, available for other hospitals after the study.
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Affiliation(s)
- Hannah Hoeben
- Department of Paediatrics/Neonatology, OLVG, 1091 AC Amsterdam, The Netherlands; (H.H.); (M.T.A.); (A.A.M.W.v.K.); (N.R.v.V.)
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Milène T. Alferink
- Department of Paediatrics/Neonatology, OLVG, 1091 AC Amsterdam, The Netherlands; (H.H.); (M.T.A.); (A.A.M.W.v.K.); (N.R.v.V.)
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Anne A. M. W. van Kempen
- Department of Paediatrics/Neonatology, OLVG, 1091 AC Amsterdam, The Netherlands; (H.H.); (M.T.A.); (A.A.M.W.v.K.); (N.R.v.V.)
| | - Johannes B. van Goudoever
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Nicole R. van Veenendaal
- Department of Paediatrics/Neonatology, OLVG, 1091 AC Amsterdam, The Netherlands; (H.H.); (M.T.A.); (A.A.M.W.v.K.); (N.R.v.V.)
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Sophie R. D. van der Schoor
- Department of Paediatrics/Neonatology, OLVG, 1091 AC Amsterdam, The Netherlands; (H.H.); (M.T.A.); (A.A.M.W.v.K.); (N.R.v.V.)
- Department of Neonatology, Wilhelmina Children’s Hospital, 3508 AB Utrecht, The Netherlands
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Franck LS, Gay CL, Hoffmann TJ, Kriz RM, Bisgaard R, Cormier DM, Joe P, Lothe B, Sun Y. Maternal mental health after infant discharge: a quasi-experimental clinical trial of family integrated care versus family-centered care for preterm infants in U.S. NICUs. BMC Pediatr 2023; 23:396. [PMID: 37563722 PMCID: PMC10413600 DOI: 10.1186/s12887-023-04211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Involvement in caregiving and tailored support services may reduce the risk of mental health symptoms for mothers after their preterm infant's neonatal intensive care unit (NICU) discharge. We aimed to compare Family-Centered Care (FCC) with mobile-enhanced Family-Integrated Care (mFICare) on post-discharge maternal mental health symptoms. METHOD This quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from three NICUs into sequential cohorts: FCC or mFICare. We analyzed post-discharge symptoms of perinatal post-traumatic stress disorder (PTSD) and depression using intention-to-treat and per protocol approaches. RESULTS 178 mothers (89 FCC; 89 mFICare) completed measures. We found no main effect of group assignment. We found an interaction between group and stress, indicating fewer PTSD and depression symptoms among mothers who had higher NICU-related stress and received mFICare, compared with mothers who had high stress and received FCC (PTSD: interaction β=-1.18, 95% CI: -2.10, -0.26; depression: interaction β=-0.76, 95% CI: -1.53, 0.006). Per protocol analyses of mFICare components suggested fewer PTSD and depression symptoms among mothers who had higher NICU stress scores and participated in clinical team rounds and/or group classes, compared with mothers who had high stress and did not participate in rounds or classes. CONCLUSION Overall, post-discharge maternal mental health symptoms did not differ between the mFICare and FCC groups. However, for mothers with high levels of stress during the NICU stay, mFICare was associated with fewer post-discharge PTSD and depression symptoms.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA.
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, Office of Research, School of Nursing, UCSF, San Francisco, CA, USA
| | - Rebecca M Kriz
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA
| | - Robin Bisgaard
- Intensive Care Nursery, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Diana M Cormier
- NICU and Pediatrics, Community Regional Medical Center, Fresno, CA, USA
| | - Priscilla Joe
- Division of Neonatology, UCSF Benioff Children's Hospital, Oakland, CA, USA
| | | | - Yao Sun
- Division of Neonatology, Department of Pediatrics, UCSF, San Francisco, CA, USA
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Bott S, Dantas Fernandez N, Narciso J, MacAlpine J, Quain N, Rettie J, Sharpe L, Diambomba Y, Al Bizri A, O’Brien K, Shah V. Building Connections with Families: Implementation of a Video-Messaging Service in the Neonatal Intensive Care Unit. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1338. [PMID: 37628337 PMCID: PMC10453278 DOI: 10.3390/children10081338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/14/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Family involvement is vital to optimize the care of infants in the neonatal intensive care unit (NICU). Various technologies have been used to support communication with parents in the NICU. The purpose of this study was to evaluate the parent and staff experience and perception of the use of a cloud-based video-messaging service in our NICU. METHODS This study was a single center observational study conducted at Mount Sinai Hospital, Toronto, Canada. Following the implementation of a video-messaging service, parent and staff surveys were distributed to evaluate their experience and perception. RESULTS Parent responses were positive with respect to how the service helped them feel: closer to their infant (100%) and reassured about their infant's care (100%). Nursing staff responses indicated that they perceived a benefit to parents (100%) and to their building a relationship with families (79%). However, they also identified time constraints (85%) and the use of the technology hardware (24%) as challenges. CONCLUSIONS The use of an asynchronous video-messaging service was perceived as beneficial to both parents and staff in the NICU. Complaints pertained to the impact of the technology on nursing workflow and the difficulty using the hardware provided for use of the service.
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Affiliation(s)
- Stephanie Bott
- Department of Nursing, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (S.B.); (N.D.F.); (J.N.); (J.M.)
| | - Nicole Dantas Fernandez
- Department of Nursing, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (S.B.); (N.D.F.); (J.N.); (J.M.)
| | - Janet Narciso
- Department of Nursing, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (S.B.); (N.D.F.); (J.N.); (J.M.)
| | - Janet MacAlpine
- Department of Nursing, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (S.B.); (N.D.F.); (J.N.); (J.M.)
| | - Nicole Quain
- Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (N.Q.); (J.R.); (L.S.); (Y.D.); (A.A.B.); (V.S.)
| | - Julia Rettie
- Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (N.Q.); (J.R.); (L.S.); (Y.D.); (A.A.B.); (V.S.)
| | - Lia Sharpe
- Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (N.Q.); (J.R.); (L.S.); (Y.D.); (A.A.B.); (V.S.)
| | - Yenge Diambomba
- Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (N.Q.); (J.R.); (L.S.); (Y.D.); (A.A.B.); (V.S.)
| | - Ayah Al Bizri
- Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (N.Q.); (J.R.); (L.S.); (Y.D.); (A.A.B.); (V.S.)
| | - Karel O’Brien
- Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (N.Q.); (J.R.); (L.S.); (Y.D.); (A.A.B.); (V.S.)
| | - Vibhuti Shah
- Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (N.Q.); (J.R.); (L.S.); (Y.D.); (A.A.B.); (V.S.)
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Li LP, Rao DF, Chen XX, Qi XY, Chen XX, Wang XQ, Li J. The impact of hospital-family integrated continuation nursing based on information technology on patients unhealthy mood, family function and sexual function after cervical cancer surgery. Medicine (Baltimore) 2023; 102:e33504. [PMID: 37083787 PMCID: PMC10118314 DOI: 10.1097/md.0000000000033504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/21/2023] [Indexed: 04/22/2023] Open
Abstract
The objective of this study was to explore the impact on hospital-family integrated continuation care based on information technology on the negative emotions, family function, and sexual function of patients after cervical cancer surgery. The clinical case data onto 114 postoperative cervical cancer patients who were nursing in our hospital from July 2019 to July 2021 were selected and were divided into a control group and an observation group. The control group used routine nursing care, and on this basis, the observation group used information technology as the basis for hospital-family integrated continuation care, and we observed and compared the differences in the 2 groups of patients bad mood, family function, and sexual function. The score of anxiety (P = .017), depression (P = .009), fatigue rating (P = .012), and anger (P < .001) in the observation group after care were significantly lower than those in the control group. Problem solving, role, emotional response, emotional involvement, and family function total score in the observation group after care was significantly lower than those in the control group (P < .05). Sexual desire score, sexual arousal score, vaginal lubrication score, orgasm score, sexual satisfaction score, dyspareunia score, and Female Sexual Function Inventory total scores in the observation and control groups after care were significantly higher than those before care (P < .05). The sexual function scores in the observation group after care was significantly higher than those in the control group (P < .05). The hospital-family integrated continuation care based on information technology is more effective than conventional nursing care for patients after cervical cancer surgery.
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Affiliation(s)
- Li-Ping Li
- Department of Gynaecology, Wuhan NO.1 Hospital, Wuhan, Hubei, China
| | - Dan-Feng Rao
- Department of Gynaecology, Wuhan NO.1 Hospital, Wuhan, Hubei, China
| | - Xiang-Xiang Chen
- Department of Gynaecology, Wuhan NO.1 Hospital, Wuhan, Hubei, China
| | - Xiu-Yun Qi
- Department of Rehabilitation Medicine, Wuhan NO.4 Hospital, Wuhan, Hubei, China
| | - Xiao-Xue Chen
- Department of Gynaecology, Wuhan NO.1 Hospital, Wuhan, Hubei, China
| | - Xiao-Qing Wang
- Department of Gynaecology, Wuhan NO.1 Hospital, Wuhan, Hubei, China
| | - Jing Li
- Department of Gynaecology, Taikang Tongji (Wuhan) Hospital, Wuhan, Hubei, China
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Yance B, Do K, Heath J, Fucile S. Parental Perceptions of the Impact of NICU Visitation Policies and Restrictions Due to the COVID-19 Pandemic: A Qualitative Study. Adv Neonatal Care 2023:00149525-990000000-00062. [PMID: 37036934 DOI: 10.1097/anc.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND The COVID-19 pandemic has impacted parents' ability to participate in their infants' care during the neonatal intensive care unit (NICU) stay in unprecedented ways. PURPOSE The purpose of this study was to explore the lived experience of parents whose infants was in the NICU during the COVID-19 pandemic. METHODS A qualitative telephone interview survey was conducted. Participants included parents of preterm infants who were born less than 34 weeks' gestation during the first wave of the COVID-19 pandemic (March 2020-August 2020). Telephone surveys were conducted through open-ended questions. A thematic content analysis identifying themes was performed after interviews were completed and transcribed. RESULTS A total of 8 mothers completed the telephone survey. Key themes from this study include parents experiencing increased stress due to the restricted visitation policies, limited opportunities to care for their infant, lack of support, and inconsistent communication regarding their infant status and COVID-19 protocols. IMPLICATIONS FOR PRACTICE Suggestions provided to enhance NICU services during the pandemic include increasing parental engagement opportunities to care for their infant in the NICU, enhanced empathy and compassion from the neonatal team, and open and transparent communication. IMPLICATIONS FOR RESEARCH Further research investigating cultural impact on parents' perspectives, perspectives of fathers, long-term impact of how parents coped after discharge from the NICU, and emotional impact on NICU staff members may be beneficial to aid improvements in NICU service delivery during the ongoing and future pandemic.
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Affiliation(s)
- Brittany Yance
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Yan Q, Gong Y, Luo Q, Yin X, Yang L, Wang H, Feng J, Xing K, Huang Y, Huang C, Fan L. Effects of a Smartphone-Based Out-of-Hospital Screening App for Neonatal Hyperbilirubinemia on Neonatal Readmission Rates and Maternal Anxiety: Randomized Controlled Trial. J Med Internet Res 2022; 24:e37843. [DOI: 10.2196/37843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background
Neonatal hyperbilirubinemia is one of the leading causes of neonatal readmission—especially severe hyperbilirubinemia and its complications—and it influences disease burden as well as neonatal and maternal health. Smartphones have been shown to have satisfactory accuracy in screening neonatal bilirubin levels, but the impact of this technology on neonatal health care service and maternal health outcomes is still unknown.
Objective
The aim of this study was to evaluate the impact of a smartphone-based out-of-hospital neonatal jaundice screening program on neonatal readmission rates for jaundice and related maternal anxiety.
Methods
This was a 2-arm, unblinded, randomized controlled trial with 30 days of intervention and follow-up periods. From August 2019 to August 2020, healthy mother-infant dyads were recruited on-site from 3 public hospitals in Hainan, China. Intervention group mothers used the smartphone app to routinely monitor neonatal jaundice at home under the web-based guidance of pediatricians. Control group participants received routine care. The primary study outcome was the neonatal readmission rate due to jaundice within 30 days of the first hospital discharge. The secondary outcome was the maternal anxiety score associated with neonatal jaundice. The data were collected through a self-assessed questionnaire. All participants were included in the analysis (intention-to-treat).
Results
In this study, 1424 mother-infant dyads were recruited, comprising 1424 mothers and 1424 newborns. The median age
of the mothers was 29 (IQR 26-32) years, and there were 714 (50.1%) male neonates. These mother-infant dyads were randomly
assigned to the intervention group and the control group, with 712 dyads in each group; only 1187 of these dyads completed the
follow-up. We found that the adjusted 30-day neonatal readmission rate due to jaundice reduced by 10.5% (71/605, 11.7% vs
141/582, 24.2%; 95% CI 5%-15.9%; odds ratio 0.4, 95% CI 0.3-0.5; P<.001) and the relevant maternal anxiety mean score
decreased by 3.6 (95% CI –4.4 to –2.8; β=–3.6, 95% CI –4.5 to –2.8; P<.001) in the intervention group compared to those in the
routine care group.
Conclusions
Our study shows that the smartphone-based out-of-hospital screening method for neonatal hyperbilirubinemia decreased the neonatal readmission rate within 30 days from the first discharge and improved maternal mental health to some degree, thus demonstrating the usefulness of this screening app for follow-up in pediatric care.
Trial Registration
China Clinical Trial Registration Center, ChiCTR2100049567; http://www.chictr.org.cn/showproj.aspx?proj=64245
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Franck LS, Gay CL, Hoffmann TJ, Kriz RM, Bisgaard R, Cormier DM, Joe P, Lothe B, Sun Y. Neonatal outcomes from a quasi-experimental clinical trial of Family Integrated Care versus Family-Centered Care for preterm infants in U.S. NICUs. BMC Pediatr 2022; 22:674. [PMID: 36418988 PMCID: PMC9682629 DOI: 10.1186/s12887-022-03732-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Family Integrated Care (FICare) benefits preterm infants compared with Family-Centered Care (FCC), but research is lacking in United States (US) Neonatal Intensive Care Units (NICUs). The outcomes for infants of implementing FICare in the US are unknown given differences in parental leave benefits and health care delivery between the US and other countries where FICare is used. We compared preterm weight and discharge outcomes between FCC and mobile-enhanced FICare (mFICare) in the US. METHODS In this quasi-experimental study, we enrolled preterm infant (≤ 33 weeks)/parent dyads from 3 NICUs into sequential cohorts: FCC or mFICare. Our primary outcome was 21-day change in weight z-scores. Our secondary outcomes were nosocomial infection, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and human milk feeding (HMF) at discharge. We used intention-to-treat analyses to examine the effect of the FCC and mFICare models overall and per protocol analyses to examine the effects of the mFICare intervention components. FINDINGS 253 infant/parent dyads participated (141 FCC; 112 mFICare). There were no parent-related adverse events in either group. In intention-to-treat analyses, we found no group differences in weight, ROP, BPD or HMF. The FCC cohort had 2.6-times (95% CI: 1.0, 6.7) higher odds of nosocomial infection than the mFICare cohort. In per-protocol analyses, we found that infants whose parents did not receive parent mentoring or participate in rounds lost more weight relative to age-based norms (group-difference=-0.128, CI: -0.227, -0.030; group-difference=-0.084, CI: -0.154, -0.015, respectively). Infants whose parents did not participate in rounds or group education had 2.9-times (CI: 1.0, 9.1) and 3.8-times (CI: 1.2, 14.3) higher odds of nosocomial infection, respectively. CONCLUSION We found indications that mFICare may have direct benefits on infant outcomes such as weight gain and nosocomial infection. Future studies using implementation science designs are needed to optimize intervention delivery and determine acute and long-term infant and family outcomes. CLINICAL TRIAL REGISTRATION NCT03418870 01/02/2018.
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Affiliation(s)
- Linda S. Franck
- grid.266102.10000 0001 2297 6811Department of Family Health Care Nursing, University of California San Francisco (UCSF), Box 0606, 2 Koret Way, N411F, CA 94143 San Francisco, USA
| | - Caryl L. Gay
- grid.266102.10000 0001 2297 6811Department of Family Health Care Nursing, University of California San Francisco (UCSF), Box 0606, 2 Koret Way, N411F, CA 94143 San Francisco, USA
| | - Thomas J. Hoffmann
- grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, Office of Research, School of Nursing, UCSF, San Francisco, CA USA
| | - Rebecca M. Kriz
- grid.266102.10000 0001 2297 6811Department of Family Health Care Nursing, University of California San Francisco (UCSF), Box 0606, 2 Koret Way, N411F, CA 94143 San Francisco, USA
| | - Robin Bisgaard
- grid.414016.60000 0004 0433 7727Intensive Care Nursery, UCSF Benioff Children’s Hospital, San Francisco, CA USA
| | - Diana M. Cormier
- grid.413544.30000 0004 0439 7252NICU and Pediatrics, Community Regional Medical Center, Fresno, CA USA
| | - Priscilla Joe
- grid.414016.60000 0004 0433 7727Division of Neonatology, UCSF Benioff Children’s Hospital, Oakland, CA USA
| | | | - Yao Sun
- grid.266102.10000 0001 2297 6811Division of Neonatology, Department of Pediatrics, UCSF, San Francisco, CA USA
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Implementation Outcomes and Challenges of Partnerships between Resource Parents and Parents with Sick Infants in Intensive Neonatal Care Units: A Scoping Review. CHILDREN 2022; 9:children9081112. [PMID: 35892615 PMCID: PMC9331213 DOI: 10.3390/children9081112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022]
Abstract
Parents with a sick child in a neonatal intensive care unit (NICU) usually experience stress, anxiety, and vulnerability. These precarious feelings can affect early parent–child interactions and have consequences for the child’s neurodevelopment. Parents who have had a sick child in an NICU (veteran parents) can offer helpful interventions for these vulnerable families. This article is a scoping review of parental interventions used with the families of NICU infants, and an overview of French perspectives. Two independent reviewers studied the scientific literature published in English between 2001 to 2021 using Covidence software. The databases used were MEDLINE, ISI Web of Science, the Cochrane Database, and Google Scholar. Themes were identified from the articles’ results using an open coding approach. The data are presented in a narrative format. Ten articles were included, and four major themes addressed: (1) description of activities, (2) recommendations, (3) impact, and (4) barriers (resulting from recruitment, training, remuneration, and organization). Activities were very diverse, and a step-by-step implementation was recommended by all authors. Peer-support interventions might be a potential resource for those anxious parents and improve their NICU experiences. These challenges are described by SOS Préma in France. This article brings together recent studies on partnership in the NICU. It is an innovative topic in neonatology with vast issues to explore.
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13
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Liang X, Miao A, Zhang W, Li M, Xing Y. Effect of family integrated care on physical growth and language development of premature infants: a retrospective study. Transl Pediatr 2022; 11:965-977. [PMID: 35800279 PMCID: PMC9253945 DOI: 10.21037/tp-22-210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/27/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Premature birth (PTB) increases the long-term risk of diseases such as hypertension, heart disease, and diabetes in adulthood. It is an independent disease with the largest global burden in terms of high mortality and lifelong negative health impacts. The purpose of this study was to analyze the physical growth and language development of premature infants (PIs) at the age of 18 months, and to explore the impact of family integrated care (FIcare) on PI. METHODS This study retrospectively included mothers and their PIs born in the Neonatal Pediatrics Department, Affiliated Hospital of Nantong University from January 2018 to September 2020 and hospitalized in the neonatal intensive care unit (NICU) within 24 hours after birth. The weight, head circumference, body length, and language development of each child were followed up at the age of 1, 3, 6, 12, and 18 months and recorded, and the relationship between FIcare and physical growth and language development of PIs was evaluated. RESULTS The development quotient (DQ) score and language development score of the FIcare group were always higher than those of the control group from 6 to 18 months, and the difference was statistically significant (P<0.05). Multiple regression analysis showed that the body length of the FIcare group participants was longer than that of control group participants. The head circumference of infants was positively correlated with gestational age, birth head circumference, and family average monthly income. The head circumference of FIcare group participants was longer than that of control group participants. The DQ score was positively correlated with gestational age, and the FIcare group participants scored higher than control group participants. Logistic regression analysis showed that early language milestone (ELM) scale score and gestational age were positively correlated with mother's education, and the score of FIcare group participants was higher than that of control group participants (P<0.05). CONCLUSIONS Compared with the traditional nursing model, the implementation of FIcare for the hospitalized PIs in the NICU can actively promote the physical growth and language development of infants.
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Affiliation(s)
- Xiangyan Liang
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Aimei Miao
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Wei Zhang
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Min Li
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Yan Xing
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
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Cabrera-Lafuente M, Alonso-Díaz C, Pumarega MTM, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey. An Pediatr (Barc) 2022; 96:300-308. [PMID: 35523686 DOI: 10.1016/j.anpede.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE To present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All scores ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breast feeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
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Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Laura N Haiek
- Ministère de la santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canada; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Denmark
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Mother-Newborn Care Unit (MNCU) Experience in India: A Paradigm Shift in Care of Small and Sick Newborns. Indian J Pediatr 2022; 89:484-489. [PMID: 35244878 PMCID: PMC8895087 DOI: 10.1007/s12098-022-04145-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/02/2022] [Indexed: 11/06/2022]
Abstract
While a Cochrane review (2016) showed that kangaroo mother care (KMC) initiated after clinical stabilization reduces mortality by 40%, evidence of the effect of initiating KMC immediately after birth without waiting for babies to become stable was unavailable until recently. This research gap was addressed by a multicountry, randomized, controlled trial co-ordinated by WHO. This trial was conducted in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania. Implementation of this trial led to development of the "mother-newborn care unit (MNCU)." Mother-newborn care unit or mother-newborn intensive care unit (M-NICU) is a facility where sick and small newborns are cared with their mothers 24 × 7 with all facilities of level II newborn care and provision for postnatal care to mothers. The mother is not a mere visitor, but she has her bed inside the special newborn care unit (SNCU)/newborn intensive care unit (NICU) and as a resident of MNCU, becomes an active caregiver and is involved in continuum of neonatal care. The study results show that intervention babies in MNCU had 25% less mortality at 28 d of life, 35% less incidence of hypothermia, and 18% less suspected sepsis as compared to control babies cared in conventional NICU. World Health Organization is in the process of reviewing the current recommendations on care of preterm or LBW newborns considering new evidence that has become available. However, it would require national policy change to permit mother and surrogate in SNCU/NICU 24 × 7, making the concept of zero-separation a reality.
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Mclean MA, Scoten OC, Yu W, Ye XY, Petrie J, Church PT, Soraisham AS, Mirea LS, Weinberg J, Synnes AR, O'Brien K, Grunau RE. Lower Maternal Chronic Physiological Stress and Better Child Behavior at 18 Months: Follow-Up of a Cluster Randomized Trial of Neonatal Intensive Care Unit Family Integrated Care. J Pediatr 2022; 243:107-115.e4. [PMID: 34971651 DOI: 10.1016/j.jpeds.2021.12.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess whether Family Integrated Care (FICare) in the neonatal intensive care unit improves maternal chronic physiological stress and child behavior at 18 months of corrected age for infants born preterm. STUDY DESIGN Follow-up of a multicenter, prospective cluster-randomized controlled trial comparing FICare and standard care of children born at <33 weeks of gestation and parents, stratified by tertiary neonatal intensive care units, across Canada. Primary outcomes at 18 months of corrected age were maternal stress hormones (cortisol, ie, hair cumulative cortisol [HCC], dehydroepiandrosterone [DHEA]) assayed from hair samples. Secondary outcomes included maternal reports of parenting stress, child behaviors (Internalizing, Externalizing, Dysregulation), and observer-rated caregiving behaviors. Outcomes were analyzed using multilevel modeling. RESULTS We included 126 mother-child dyads from 12 sites (6 FICare sites, n = 83; 6 standard care sites, n = 43). FICare intervention significantly lowered maternal physiological stress as indicated by HCC (B = -0.22 [-0.41, -0.04]) and cortisol/DHEA ratio (B = -0.25 [-0.48, -0.02]), but not DHEA (B = 0.01 [-0.11, 0.14]). Enrollment in FICare led to lower child Internalizing (B = -0.93 [-2.33, 0.02]) and Externalizing behavior T scores (B = -0.91 [-2.25, -0.01]) via improvements to maternal HCC (mediation). FICare buffered the negative effects of high maternal HCC on child Dysregulation T scores (B = -11.40 [-23.01, 0.21]; moderation). For mothers reporting high parenting stress at 18 months, FICare was related to lower Dysregulation T scores via maternal HCC; moderated mediation = -0.17 (-0.41, -0.01). CONCLUSIONS FICare has long-term beneficial effects for mother and child, attenuating maternal chronic physiological stress, and improving child behavior in toddlerhood. CLINICAL TRIAL REGISTRATION NCT01852695.
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Affiliation(s)
- Mia A Mclean
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Olivia C Scoten
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Wayne Yu
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Julie Petrie
- BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Paige T Church
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne R Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Karel O'Brien
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; BC Women's Hospital, Vancouver, British Columbia, Canada.
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Janvier A, Asaad MA, Reichherzer M, Cantin C, Sureau M, Prince J, Luu TM, Barrington KJ. The ethics of family integrated care in the NICU: Improving care for families without causing harm. Semin Perinatol 2022; 46:151528. [PMID: 34863579 DOI: 10.1016/j.semperi.2021.151528] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The philosophy of care in Neonatal Intensive care Units (NICU) has changed with increasing integration of families. We examined parents' and clinicians' perspective about Family Integrated Care (FiCare) in our quaternary NICU. We found that parents and clinicians reported many benefits for families. They were all enthusiastic about FiCare for non-medical items such as changing diapers and skin-to-skin care; for more medical items, such as presenting at rounds, being present during resuscitation or procedures, most physicians wished for more parental involvement, more than other professionals, even parents. All parents described how FiCare benefited them, had empowered them, helped them feel like parents and become a family; but several parents, who could not participate as much or did not want to assume clinical roles, reported feeling guilty. Having a flexible, yet transparent FiCare philosophy is key, as opposed to having homogeneous goals. For example, an aim to have all parents present at rounds in a quality improvement initiative can cause harm to some families. We suggest how to ethically improve FiCare in the best interest of families while minimizing harms. It is important for FiCare not to be "Family Imposed Care." Optimizing FiCare can only be done when parents' priorities guide our actions, while also keeping in mind clinicians' perspectives and respecting the reality of each NICU.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics, Université de Montréal, Montréal, Canada; Division of Neonatology, Hôpital Sainte-Justine, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada; Bureau de l'éthique clinique (BEC), Université de Montréal, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montréal, Canada; Unité de soins palliatifs, CHU Sainte-Justine, Montréal, Canada; Unité de recherche en éthique clinique et partenariat famille (UREPAF), Canada; Bureau du Partenariat Patients-Familles-Soignants, CHU Sainte-Justine, Montréal, Canada.
| | - Michael-Andrew Asaad
- Department of Pediatrics, Université de Montréal, Montréal, Canada; Division of Neonatology, Hôpital Sainte-Justine, Montréal, Canada
| | | | - Catherine Cantin
- Division of Neonatology, Hôpital Sainte-Justine, Montréal, Canada; Bureau du Partenariat Patients-Familles-Soignants, CHU Sainte-Justine, Montréal, Canada
| | - Maia Sureau
- Parent Representative (resource parent), Canada
| | | | - Thuy Mai Luu
- Department of Pediatrics, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada
| | - Keith J Barrington
- Department of Pediatrics, Université de Montréal, Montréal, Canada; Division of Neonatology, Hôpital Sainte-Justine, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada
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Mousavi SS, Keramat A, Chaman R, Mohagheghi P, Mousavi SA, Khosravi A. Impact of Maternity Support Program on the Stress of Mothers in the First Encounter with the Preterm Infants. Int J Prev Med 2021; 12:68. [PMID: 34447510 PMCID: PMC8356949 DOI: 10.4103/ijpvm.ijpvm_314_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/18/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Mothers of premature infants experience a high level of stress. The current study was conducted aiming at investigating the impact of maternity support program on the stress of mothers in the first encounter with infants. METHODS This experimental study began in neonatal intensive care units (NICUs) of two hospitals of Tehran; that is, Mahdieh (intervention) and Shahid Akbar-Abadi (control), from Feb 14, 2016, to May 14, 2016. Both are educational and referral centers including three levels of NICU that were randomly allocated to intervention and control sites. In the span of study period all 75 infants and mothers with inclusion/exclusion criteria in the Mahdieh hospital were included in the intervention group and vis-à -vis all 68 infants and mothers in Shahid-Akbar-Abadi were enrolled in the control group. The designed intervention was conducted based on the support system pattern of mothers with premature infants in the interventional group. In the first stage of intervention, in the intervention group, mothers were provided informational, emotional, and spiritual support before and during the first exposure and were empowered for comfortable interactions. The control group received routine care. After the first exposure, the mothers' stress was measured by the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU). The data were analyzed by STATA software as well as t-test, Chi-square, and average treatment effects (ATEs) were estimated using inverse probability treatment weights (IPTW). RESULTS After adjusting pre-treatment variables by IPTW, the adjusted average difference in the stress score over the NICU environment, infant's behavior and appearance, the special treatments on him/her, and the change in the parental role and total stress were 1.47 (1.19-1.75), 1.06 (0.73-1.14), 1.21 (0.93-1.49), and 1.18 (0.93-1.44), which were lower than the control group (P < 0.001). CONCLUSIONS The intervention reduced significantly the stress of mothers. The policy-makers are suggested to conduct this method.
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Affiliation(s)
- Seyedeh S. Mousavi
- Nursing Care Research Center (NCRC), Department of Midwifery and Reproductive Health, Iran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Keramat
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Reza Chaman
- Department of Epidemioligy, School of Health, Shiraz University of Medical Science, Shiraz, Iran
| | - Parisa Mohagheghi
- Hazrate Rasoul Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed A. Mousavi
- Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahmad Khosravi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
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Waddington C, van Veenendaal NR, O’Brien K, Patel N. Family integrated care: Supporting parents as primary caregivers in the neonatal intensive care unit. Pediatr Investig 2021; 5:148-154. [PMID: 34179713 PMCID: PMC8212757 DOI: 10.1002/ped4.12277] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/21/2021] [Indexed: 01/19/2023] Open
Abstract
Family integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minimizing separation, and supporting parent-infant closeness. FICare incorporates psychological, educational, communication, and environmental strategies to support parents to cope with the NICU environment and to prepare them to be able to emotionally, cognitively, and physically care for their infant. FICare has been associated with improved infant feeding, growth, and parent wellbeing and self-efficacy; important mediators for long-term improved infant neurodevelopmental and behavioural outcomes. FICare implementation requires multi-disciplinary commitment, staff motivation, and sufficient time for preparation and readiness for change as professionals relinquish power and control to instead develop collaborative partnerships with parents. Successful FICare implementation and culture change have been applied by neonatal teams internationally, using practical approaches suited to their local environments. Strategies such as parent and staff meetings and relational communication help to break down barriers to change by providing space for the co-creation of knowledge, the negotiation of caregiving roles and the development of trusting relationships. The COVID-19 pandemic highlighted the vulnerability within programs supporting parental presence in neonatal units and the profound impacts of parent-infant separation. New technologies and digital innovations can help to mitigate these challenges, and support renewed efforts to embed FICare philosophy and practice in neonatal care during the COVID-19 recovery and beyond.
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Affiliation(s)
| | - Nicole R. van Veenendaal
- OLVGAmsterdamthe Netherlands
- Emma Children’s HospitalAmsterdam UMCUniversity of AmsterdamVrije UniversiteitAmsterdamthe Netherlands
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Cabrera-Lafuente M, Alonso-Díaz C, Moral Pumarega MT, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. [Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00178-8. [PMID: 34045162 DOI: 10.1016/j.anpedi.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE Present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All score ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breastfeeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
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Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Mariana Díaz-Almirón
- Sección de Bioestadística, IdiPAZ, Hospital Universitario La Paz, Madrid, España
| | - Laura N Haiek
- Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canadá; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Dinamarca
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Hadders-Algra M. Early Diagnostics and Early Intervention in Neurodevelopmental Disorders-Age-Dependent Challenges and Opportunities. J Clin Med 2021; 10:861. [PMID: 33669727 PMCID: PMC7922888 DOI: 10.3390/jcm10040861] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022] Open
Abstract
This review discusses early diagnostics and early intervention in developmental disorders in the light of brain development. The best instruments for early detection of cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2-4 months and from 2-4 months onwards, the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment. Early detection of autism spectrum disorders (ASD) is difficult; its first signs emerge at the end of the first year. Prediction with the Modified Checklist for Autism in Toddlers and Infant Toddler Checklist is possible to some extent and improves during the second year, especially in children at familial risk of ASD. Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries. At around 3 months the cortical subplate has dissolved in primary motor and sensory cortices; around 12 months the cortical subplate in prefrontal and parieto-temporal cortices and cerebellar external granular layer have disappeared. This review stresses that families are pivotal in early intervention. It summarizes evidence on the effectiveness of early intervention in medically fragile neonates, infants at low to moderate risk, infants with or at high risk of CP and with or at high risk of ASD.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics-Section Developmental Neurology, 9713 GZ Groningen, The Netherlands
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22
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Leak P, Yamamoto E, Noy P, Keo D, Krang S, Kariya T, Saw YM, Siek M, Hamajima N. Factors associated with neonatal mortality in a tertiary hospital in Phnom Penh, Cambodia. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 83:113-124. [PMID: 33727743 PMCID: PMC7938092 DOI: 10.18999/nagjms.83.1.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022]
Abstract
This study aimed to identify hospital neonatal mortality rate (NMR) and the causes of neonatal deaths, and to understand risk factors associated with neonatal mortality in a national tertiary hospital in Cambodia. The study included all newborn infants, aged 0-28 days old, hospitalized in the Pediatrics department of Khmer-Soviet Friendship Hospital between January 2016 and December 2017. In total, 925 infants were included in the study. The mean gestational age was 35.9 weeks (range, 24-42 weeks). Preterm infants and low birth weight accounted for 47.5% and 56.7%, respectively. With respect to payment methods, the government (53.5%) and non-governmental organizations (NGO) (13.7%) paid the fees as the families were not in a financial position to do so. The hospital NMR at the Pediatrics department was 9.3%. Respiratory distress syndrome (37.2%) was the main cause of deaths followed by hypoxic-ischemic encephalopathy (31.4%) and neonatal infection (21.0%). Factors associated with neonatal mortality were Apgar score at 5th minute <7 (adjusted odds ratio (AOR) = 3.57), payment by the government or NGO (AOR = 11.32), admission due to respiratory distress (AOR = 11.94), and hypothermia on admission (AOR = 9.41). The hospital NMR in the Pediatrics department was 9.3% (95% confidence interval 7.50-11.35) at Khmer-Soviet Friendship Hospital; prematurity and respiratory distress syndrome were the major causes of neonatal mortality. Introducing continuous positive airway pressure machine for respiratory distress syndrome and creating neonatal resuscitation guidelines and preventing hypothermia in delivery rooms are required to reduce the high NMR.
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Affiliation(s)
- Ponloeu Leak
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Pediatrics Department, Khmer-Soviet Friendship Hospital, Phnom Penh, Cambodia
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Pisey Noy
- Pediatrics Department, Khmer-Soviet Friendship Hospital, Phnom Penh, Cambodia
| | - Dane Keo
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Sidonn Krang
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Meng Siek
- Pediatrics Department, Khmer-Soviet Friendship Hospital, Phnom Penh, Cambodia
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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23
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Lammertink F, Vinkers CH, Tataranno ML, Benders MJNL. Premature Birth and Developmental Programming: Mechanisms of Resilience and Vulnerability. Front Psychiatry 2021; 11:531571. [PMID: 33488409 PMCID: PMC7820177 DOI: 10.3389/fpsyt.2020.531571] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022] Open
Abstract
The third trimester of pregnancy represents a sensitive phase for infant brain plasticity when a series of fast-developing cellular events (synaptogenesis, neuronal migration, and myelination) regulates the development of neural circuits. Throughout this dynamic period of growth and development, the human brain is susceptible to stress. Preterm infants are born with an immature brain and are, while admitted to the neonatal intensive care unit, precociously exposed to stressful procedures. Postnatal stress may contribute to altered programming of the brain, including key systems such as the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. These neurobiological systems are promising markers for the etiology of several affective and social psychopathologies. As preterm birth interferes with early development of stress-regulatory systems, early interventions might strengthen resilience factors and might help reduce the detrimental effects of chronic stress exposure. Here we will review the impact of stress following premature birth on the programming of neurobiological systems and discuss possible stress-related neural circuits and pathways involved in resilience and vulnerability. Finally, we discuss opportunities for early intervention and future studies.
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Affiliation(s)
- Femke Lammertink
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Christiaan H. Vinkers
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Maria L. Tataranno
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Manon J. N. L. Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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24
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Hei M, Gao X, Li Y, Gao X, Li Z, Xia S, Zhang Q, Han S, Gao H, Nong S, Zhang A, Li J, Wang Y, Ye XY, Lee SK. Family Integrated Care for Preterm Infants in China: A Cluster Randomized Controlled Trial. J Pediatr 2021; 228:36-43.e2. [PMID: 32898578 DOI: 10.1016/j.jpeds.2020.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore whether family integrated care (FICare) is feasible and improves the outcomes of preterm infants in China. STUDY DESIGN This was a multicenter prospective cluster-randomized controlled trial comparing FICare and standard care. The primary outcome was length of stay (LOS). Secondary outcomes were nosocomial infections, duration of supplemental oxygen, breastfeeding, and weight gain. Outcomes were compared using univariate and multivariable analyses adjusted for potential confounders and clustering. RESULTS We enrolled 601 preterm infants from 11 neonatal intensive care units (FICare, n = 298; control, n = 303). The unadjusted LOS was 30.81 vs 30.26 days (mean ratio, 1.02; 95% CI, 0.85-1.22; P = .85). After adjustment, outcomes in the FICare group were improved compared with the control group, including LOS (28.26 vs 35.04 days; mean ratio, 0.81; 95% CI, 0.72-0.91), total medical expenditures (mean ratio, 0.69; 95% CI, 0.53-0.90), weight gain velocity (15.73 vs 10.30 g/day; mean difference, 5.43; 95% CI, 3.65-7.21), duration of supplemental oxygen (13.11 vs 21.42 days; mean difference, 0.71; 95% CI, 0.50-1.00), nosocomial infection rates (4.13 vs 5.84/1000 hospital days; mean ratio, 0.67; 95% CI, 0.47-0.96), antibiotic exposure (38.63 vs 57.32/100 hospital days; mean ratio, 0.67; 95% CI, 0.47-0.96), breastfeeding rates (87.25% vs 55.78%; OR, 5.42; 95% CI, 3.25-9.05), and rehospitalization rates (3.65% vs 7.48%; OR, 0.47; 95% CI, 0.28-0.77). At follow-up to 18 months, breastfeeding rates and weight were significantly (P < .05) higher over time in the FICare group. CONCLUSIONS FICare was feasible in Chinese neonatal intensive care units and was associated with reduced hospital LOS, medical expenditures, and rates of adverse outcomes.
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Affiliation(s)
- Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center of Children's Health, Beijing, China.
| | - Xiangyu Gao
- Department of Pediatrics, Southeast University Affiliated Xuzhou Hospital, Xuzhou, Jiangsu, China
| | - Ying Li
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xirong Gao
- Department of Neonatology, Hunan Children's Hospital, Changsha, Hunan, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women and Children's Hospital, Xi'an, Shaanxi, China
| | - Shiwen Xia
- Department of Neonatology, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Qianshen Zhang
- Department of Neonatology, Shenzhen Maternal and Childcare Hospital, Shenzhen, Guangdong, China
| | - Shuping Han
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Hongxia Gao
- Department of Neonatology, Gansu Provincial Maternity and Childcare Hospital, Lanzhou, Gansu, China
| | - Shaohan Nong
- Department of Pediatrics, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Aimin Zhang
- Department of Neonatology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Jia Li
- Department of Neonatology, Kunming Maternal and Child Healthcare Hospital, Kunming, Yunnan, China
| | - Yanchen Wang
- Chinese Neonatal Network, Fudan Children's Hospital, Shanghai, China
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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25
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Ferreira A, Ferretti E, Curtis K, Joly C, Sivanthan M, Major N, Daboval T. Parents' Views to Strengthen Partnerships in Newborn Intensive Care. Front Pediatr 2021; 9:721835. [PMID: 34646796 PMCID: PMC8504452 DOI: 10.3389/fped.2021.721835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Parental involvement in their newborn's neonatal intensive care reduces stress and helps with the parent-child attachment, transition to home, and future development. However, parents' perspectives are not often sought or considered when adapting family-centered care in neonatal intensive care units (NICUs). Aim: To identify what parents believe helps or hinders their involvement in their newborn's care when admitted to our Level 3B NICU. Methods: Between August and October 2018, nine mothers and one father were interviewed during three 60- to 90-min audiotaped focus groups using a semi-structured interview tool. From the content analysis of the verbatims, three reviewers identified key themes that affected how involved parents could be in their newborn's care. Results: Parents provided examples of factors that facilitated or restricted their involvement. The analysis identified themes: (1) parent-staff interactions, (2) supportive/trustworthy healthcare professionals, (3) consistency in care and caring staff, (4) family, couple, and peer support, (5) newborn status, (6) resources and education for parents, (7) the NICU environment, and (8) academic and research participation. Conclusion: We identified a conceptual framework to allow our NICU team to prioritize working strategies to strengthen parental involvement in newborn care. In addition to implementing ways to involve parents, we need to address parents' satisfaction with their participation. These findings may help other investigators explore parents' expectations toward their NICU experience.
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Affiliation(s)
- Alexie Ferreira
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Emanuela Ferretti
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Neonatal Intensive Care Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Cynthia Joly
- Neonatal Intensive Care Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Myuri Sivanthan
- Health Care Systems Division, Health Canada, Ottawa, ON, Canada.,Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Nathalie Major
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Thierry Daboval
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Neonatal Intensive Care Unit, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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26
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Moreno-Sanz B, Montes MT, Antón M, Serrada MT, Cabrera M, Pellicer A. Scaling Up the Family Integrated Care Model in a Level IIIC Neonatal Intensive Care Unit: A Systematic Approach to the Methods and Effort Taken for Implementation. Front Pediatr 2021; 9:682097. [PMID: 34178899 PMCID: PMC8219911 DOI: 10.3389/fped.2021.682097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Family Integrated Care (FICare) integrates parents in the direct care of their child while the healthcare personnel act as teachers and guides. To this date, most reports on the feasibility of this model refer to stable preterm infants admitted to Neonatal Intensive Care Units (NICUs). Objectives: To scale up and adapt FICare to make it suitable in level IIIC NICUs, which care for extreme prematurity and other complex medical or surgical neonatal conditions. Materials and Methods: Step 1 was the creation of the FICare implementation team (FICare-IT) and baseline analysis of current procedures for critical care to identify needs, wishes, and requirements; we aimed for protocol elaboration tailored to our cultural, architectural, and clinical context (March 2017 to April 2018). Step 2 as a dissemination strategy by FICare-IT acting as primary trainers and mentors to ensure the education of 90% of nursing staff (May 2018 to July 2018). Step 3 involved piloting and evaluation with the aim to refine the procedure (July 2018 to December 2020). Results: A rigorous but flexible protocol was edited. The FICare educational manual included two curricula: for healthcare professionals/staff (Training the trainers) and for families (Education of caregivers), the latter being categorized in two intervention levels (basic and advanced), depending on the infant care needs and parent's decision. In total, 76 families and 91 infants (74.7% preterm; 18.7% complex surgery; 6.6% others) were enrolled in the pilot. No differences in acceptance rate (overall 86.4%) or in the number of infant-family dyads in the program per month were observed when considering the pre- and post-Covid-19 pandemic periods. All families, except for one who dropped out of the program, completed the agreed individualized training. Mothers spent more time in NICU than fathers (p < 0.05); uninterrupted time spent by mothers in NICU was longer during the pre-pandemic period (p < 0.01). Observed time to reach proficiency by task was within the expected time in 70% of the program contents. The parents revealed educational manuals, workshops, and cot-side teaching sessions as essential for their training, and 100% said they would accept entry into the FICare program again. Conclusions: The principles of the FICare model are suitable for all levels of care in NICUs. Leadership and continuous evaluation/refinement of implementation procedures are essential components to achieve the objectives.
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Affiliation(s)
- Bárbara Moreno-Sanz
- Department of Neonatology, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research-IdIPAZ, La Paz University Hospital, Madrid, Spain
| | - María Teresa Montes
- Department of Neonatology, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research-IdIPAZ, La Paz University Hospital, Madrid, Spain
| | - Marta Antón
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | | | - Marta Cabrera
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research-IdIPAZ, La Paz University Hospital, Madrid, Spain
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27
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Church PT, Grunau RE, Mirea L, Petrie J, Soraisham AS, Synnes A, Ye XY, O'Brien K. Family Integrated Care (FICare): Positive impact on behavioural outcomes at 18 months. Early Hum Dev 2020; 151:105196. [PMID: 32987227 DOI: 10.1016/j.earlhumdev.2020.105196] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/16/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children born very preterm demonstrate behavioural challenges due to clinical factors, exposure to the high stress environment of intensive care, and separation from parents during neonatal hospitalization at a critical stage in development. Family Integrated Care (FICare) significantly reduced parent stress and anxiety, and improved neonatal outcomes. AIMS To examine the impact of FICare on behavioural outcomes at 18-21 months corrected age (CA), and assess possible mediation through parenting or infant growth. STUDY DESIGN AND METHODS A prospective cohort study enrolling infants under 33 weeks gestation and parents from the FICare cluster randomized controlled trial. Primary outcome was behaviour assessed by the Infant Toddler Social Emotional Assessment (ITSEA). Parent child variables were measured with the Nursing Child Assessment Satellite Training (NCAST), Parenting Stress Index (PSI) and infant growth. RESULTS Subjects included 123 FICare infants and 62 standard care controls evaluated at 18-21 months CA. FICare infants demonstrated lower ITSEA Dysregulation, indicating better self-regulation skills, compared with the control group (T-score 41.7 vs 46.6, p < 0.01). At 12 months CA, the NCAST Child subtotal score was higher and the PSI-Child Domain score was lower in FICare infants than non-FICare infants. The PSI-Child domain was identified as a possible mediator of FICare on child behaviour (mediation effect 1.28, -2.96-0.02, p = 0.044). CONCLUSION FICare in the NICU has a sustained effect on child behaviour, improving self-regulation at 18-21 months CA.
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Affiliation(s)
- Paige Terrien Church
- Sunnybrook Health Sciences Centre, Department of Newborn and Developmental Paediatrics, 2075 Bayview Avenue, M4-234, Toronto, ON M4N 3M5, Canada; University of Toronto, Department of Paediatrics, 27 King's College Cir, Toronto, ON M5S 3H7, Canada
| | - Ruth E Grunau
- University of British Columbia, Department of Pediatrics and BC Children's Research Institute, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada; BC Women's Hospital, 4500 Oak St, Vancouver, BC V6H 3N4, Canada
| | - Lucia Mirea
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Suite 8-500, Toronto, ON M5G 1X6, Canada
| | - Julie Petrie
- BC Women's Hospital, 4500 Oak St, Vancouver, BC V6H 3N4, Canada
| | - Amuchou Singh Soraisham
- Alberta Children's Hospital Research Institute, Foothills Medical Centre, University of Calgary, 1403, 29th Street NW, Calgary, AB T2N 2T9, Canada
| | - Anne Synnes
- University of British Columbia, Department of Pediatrics and BC Children's Research Institute, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada; BC Women's Hospital, 4500 Oak St, Vancouver, BC V6H 3N4, Canada
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Suite 8-500, Toronto, ON M5G 1X6, Canada
| | - Karel O'Brien
- University of Toronto, Department of Paediatrics, 27 King's College Cir, Toronto, ON M5S 3H7, Canada; Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Suite 8-500, Toronto, ON M5G 1X6, Canada; Mount Sinai Hospital, Department of Paediatrics, 600 University Avenue, Toronto, ON M5G 1X5, Canada.
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28
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van den Hoogen A, Eijsermans R, Ockhuijsen HDL, Jenken F, Oude Maatman SM, Jongmans MJ, Verhage L, van der Net J, Latour JM. Parents' experiences of VOICE: A novel support programme in the NICU. Nurs Crit Care 2020; 26:201-208. [PMID: 33124117 PMCID: PMC8246858 DOI: 10.1111/nicc.12569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
Background Admission of an infant to a neonatal intensive care unit (NICU) is often a stressful experience for parents and can be associated with feelings of inadequacy to fulfil the desirable parental role. The values, opportunities, integration, control, and evaluation (VOICE) programme was developed to engage parents in care, to decrease stress, and to increase empowerment. Aim To explore the experiences of parents regarding involvement in the VOICE programme during admission of their infant to the NICU. Design The VOICE programme includes at least five personal structured meetings between parents, nurses, and other health care professionals throughout the pathway from birth, NICU, and follow up. A qualitative design was adopted using semi‐structured interviews. Interviews with 13 parents of 11 infants born at <27 weeks' gestational age were conducted: nine mothers and two couples of father and mother. Thematic analysis was deployed. Results The findings have been described in one overarching theme: “parental empowerment.” Parents felt strengthened and were empowered in the development of their role as primary caretaker by the VOICE programme. The parental empowerment theme emerged from four related interpretive themes that were derived: (a) involvement in care, (b) personalized information and communication, (c) transition to a parental role, and (d) emotional support. Conclusion The VOICE programme can be a structured approach used to implement family support in a NICU to empower parents to become a partner in the care of their infant and feel confident. Relevance to clinical practice This study encourages health care professionals to provide parental support through a structured intervention programme, which contributes to the empowerment of parents in the NICU and encouraged them to participate in care and decision‐making.
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Affiliation(s)
- Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rian Eijsermans
- Centre for Child Development Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Henriette D L Ockhuijsen
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Floor Jenken
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sabine M Oude Maatman
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marian J Jongmans
- Department of Education and Pedagogy, Utrecht University, Utrecht, The Netherlands
| | - Lianne Verhage
- Centre for Child Development Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Janjaap van der Net
- Centre for Child Development Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
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29
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Xiang X, Xia S, Zhu X, Gao X, Gao X, Zhang A, Lee SK, Hei M. Attitudes and concerns of neonatologists and nurses to family-integrated-care in neonatal intensive care units in China. Transl Pediatr 2020; 9:603-609. [PMID: 33209722 PMCID: PMC7658773 DOI: 10.21037/tp-20-60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Parents in China are denied visitation of their newborns in neonatal intensive care unit (NICU), leading to a prolonged period of parent-infant separation. The family-integrated care (FICare) model, which supports the integration of parents into the NICU team, is gradually being introduced in China. Considering resistance to the implementation of FICare, this study aimed to assess the attitudes and concerns of neonatologists and nurses towards FICare in China. METHODS Using a before and after study design, a qualitative analysis was conducted to determine the perceptions and attitudes of medical professionals towards FICare in China. A total of 34 neonatologists and 94 nurses from 5 tertiary NICUs in China were enrolled. A self-developed questionnaire was used. The study steps included reading session and then survey for the first time (survey 1), a FICare getting buy-in education session (4 hours), a group discussion session, and finally repeat the questionnaire (survey 2). The surveys were completed by trained researchers regarding willingness, acceptance and concerns of implementing FICare in NICUs in China. Differences in attitudes towards FICare were compared between groups (Chi-square/correction for continuity). RESULTS There are positive responses in neonatologists and nurses regarding the necessity (Survey 1: 58.8% and 57.4%; Survey 2: 88.2% and 67.0%), feasibility (Survey 1: 17.6% and 19.1%; Survey 2: 32.3% and 34.0%), and interest in joining FICare (Survey 1: 82.4% and 83.0%; Survey 2: 97.1% and 85.1%). A higher proportion of neonatologists indicated that FICare could promote breastfeeding in the NICU comparing to nurses (Survey 1: 47.1% vs. 19.1%; Survey 2: 61.8% and 46.8% respectively). Most of the neonatologists and nurses are not sure whether FICare can shorten the hospital stay (Survey 1: 82.3% and 68.1%; Survey 2: 85.3% and 60.6%) or improve the doctor-patient relationship (Survey 1: 58.8% and 68.1%; Survey 2: 73.5% and 69.1%). Challenges concerning the implementation of FICare were identified as inadequate ward space, lack of human resources, and potential increases in nosocomial infection. CONCLUSIONS The getting buy-in education program in introducing new paradigms of neonatal care may help on how to design and implement more effective educational tools for FICare.
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Affiliation(s)
- Xiying Xiang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,National Center for Child Health, Beijing, China
| | - Shiwen Xia
- Department of Neonatology, Hubei Province Women and Children Hospital, Wuhan, China
| | - Xing Zhu
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiangyu Gao
- Department of Pediatrics, Southeast University Affiliated Xuzhou Hospital, Xuzhou, China
| | - Xirong Gao
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
| | - Aiming Zhang
- Department of Pediatrics, Hunan Provincial People's Hospital, Changsha, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,National Center for Child Health, Beijing, China
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30
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Abstract
OBJECTIVE Our objective was to explore the case for adoption of flexibility as a core value in the design process for Neonatal Intensive Care Units (NICUs). METHODS Guidelines for NICU design and care of NICU patients and families were examined to identify opportunities for building flexibility into NICU design to optimize function and experience. RESULTS Benefits of building flexibility into NICU design included the ability for units to adapt quickly and economically to unpredictable events and demographic changes. Further, by centering family presence as a design necessity, NICUs may better protect families from experiencing additional harm due to separation and interruption of restorative activities. We were able to highlight several examples of current NICUs, which have successfully adopted flexible design and operational models to provide optimal levels of clinical and family-centered care. CONCLUSION By intentionally incorporating flexibility into the design of an NICU, infants, families, and healthcare providers can be provided with an environment that can adapt to shifting needs to optimally support unit function and clinical outcomes.
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Ringham CL, MacKinnon K. Mothering Work and Perinatal Transfer: An Institutional Ethnographic Investigation. Can J Nurs Res 2019; 53:27-38. [PMID: 31684752 DOI: 10.1177/0844562119884388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While maternal or infant transfer is generally the safest course of action when health complications arise, the process of shifting from one hospital to another is stressful for mothers and their infants. There is limited understanding of how institutional processes coordinate patient transfer in ways that increase tensions for women and their families who are trying to navigate the institutional systems during health crises. METHODS This institutional ethnographic study explored womens' experience of transfer. Interviews were conducted with a purposive sample of six childbearing women. The analysis highlights tensions and contradictions between patient care and institutional demands and shows how ordinary institutional decision-making practices impacted participants in unexpected ways. RESULTS Women experienced uncertainty and stress when trying to convince health-care providers they needed care. Before, during, and after transfer, participants navigated home responsibilities, childcare, and getting care closer to home in difficult circumstances. CONCLUSION The effort and skill women need to care for their infants and families as they are transferred is extraordinary. This study offers insight into the resources and support childbearing women need to accomplish the work of caring for their families in the face of perinatal crisis and multiple transfers.
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Affiliation(s)
- Catherine L Ringham
- Faculty of Nursing and Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Karen MacKinnon
- School of Nursing, University of Victoria, Victoria, BC, Canada
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Cheng C, Franck LS, Ye XY, Hutchinson SA, Lee SK, O'Brien K. Evaluating the effect of Family Integrated Care on maternal stress and anxiety in neonatal intensive care units. J Reprod Infant Psychol 2019; 39:166-179. [PMID: 31502862 DOI: 10.1080/02646838.2019.1659940] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To identify how Family Integrated Care (FICare) affected maternal stress and anxiety. Study Design: This secondary analysis of the FICare cluster randomised controlled trial included infants born between 1 April 2013 and 31 August 2015 at ≤33 weeks' gestation. Mothers completed the PSS:NICU and STAI questionnaires at enrolment and study day 21. Results: 1383 mothers completed the surveys at one or both time-points. The mean PSS:NICU and STAI scores at day 21 were significantly lower in the FICare mothers than controls (PSS:NICU mean [standard deviation] FICare 2.32 [0.75], control 2.48 [0.78], p = 0.0005; STAI FICare 70.8 [20.0], control 74.2 [19.6], p = 0.0004). The sights and sounds, looks and behaviour, and parental role PSS:NICU subscales and the state and trait STAI subscales were all significantly different between FIC are and controls at day 21. The magnitude of change in all stress and anxiety subscales was greater in the FICare group than controls. These differences remained significant after adjustment for confounders with the greatest change in the parental role (least-squares mean [95% confidence interval] FICare -0.65 [-0.72, 0.57], control -0.31 [-0.38, -0.24], p < 0.0001) and state anxiety subscales. Conclusion: FICare is effective at reducing NICU-related maternal stress and anxiety.
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Affiliation(s)
- Chelsea Cheng
- Department of Paediatrics, Sinai Health System , Toronto, Ontario, Canada
| | - Linda S Franck
- Family Health Care Nursing, University of California San Francisco , San Francisco, CA, USA
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital , Toronto, Ontario, Canada
| | - Sarah A Hutchinson
- Maternal-Infant Care Research Centre, Mount Sinai Hospital , Toronto, Ontario, Canada
| | - Shoo K Lee
- Department of Paediatrics, Sinai Health System , Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, Mount Sinai Hospital , Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto , Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology and Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada
| | - Karel O'Brien
- Department of Paediatrics, Sinai Health System , Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, Mount Sinai Hospital , Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology and Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada
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Milette I, Martel MJ, da Silva MR, Coughlin McNeil M. Guidelines for the Institutional Implementation of Developmental Neuroprotective Care in the NICU. Part B: Recommendations and Justification. A Joint Position Statement From the CANN, CAPWHN, NANN, and COINN. Can J Nurs Res 2019; 49:63-74. [PMID: 28841057 DOI: 10.1177/0844562117708126] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The use of age-appropriate care as an organized framework for care delivery in the NICU is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the "universe of developmental care" conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the NICU. These guidelines were recently revised and expanded. In alignment with the Joint Commission's requirement for healthcare professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of these core measures require a strong framework for institutional operationalization presented in these guidelines. Part B will present the recommendations and justification of each steps behind the present guidelines to facilitate their implementation.
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Affiliation(s)
- Isabelle Milette
- 1 NNP, Neonatal Intensive Care Unit, Mother and Child University Hospital Center Sainte-Justine, Montréal, Québec, Canada.,2 Quebec Nursing Intervention Research Network (RRISIQ), Québec, Canada
| | - Marie-Josée Martel
- 2 Quebec Nursing Intervention Research Network (RRISIQ), Québec, Canada.,3 University of Québec in Trois-Rivières, Trois-Rivières, Canada.,4 Associate researcher, Sainte-Justine University Hospital Research Center, Montréal, Québec, Canada.,5 Regular researcher, Centre d'études interdisciplinaires sur le développement de l'enfant et la famille (CEIDEF), University of Québec in Trois-Rivières, Trois-Rivières, Canada
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The effectiveness of a parent participation improvement program for parents on partnership, attachment infant growth in a neonatal intensive care unit: A randomized controlled trial. Int J Nurs Stud 2019; 95:19-27. [DOI: 10.1016/j.ijnurstu.2019.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 11/23/2022]
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Franck LS, O'Brien K. The evolution of family-centered care: From supporting parent-delivered interventions to a model of family integrated care. Birth Defects Res 2019; 111:1044-1059. [PMID: 31115181 DOI: 10.1002/bdr2.1521] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022]
Abstract
There is increasing recognition that parents play a critical role in promoting the health outcomes of low birthweight and preterm infants. Despite a large body of literature on interventions and models to support family engagement in infant care, parent involvement in the delivery of care for such infants is still restricted in many neonatal intensive care units (NICUs). In this article, we propose a taxonomy for classifying parent-focused NICU interventions and parent-partnered care models to aid researchers, clinical teams, and health systems to evaluate existing and future approaches to care. The proposed framework has three levels: interventions to support parents, parent-delivered interventions, and multidimensional models of NICU care that explicitly incorporate parents and partners in the care of their preterm or low birthweight infant. We briefly review the available evidence for interventions at each level and highlight the strong level of research evidence to support the parent-delivered intervention of skin-to-skin contact (also known as the Kangaroo Care position) and for the Kangaroo mother care and family integrated care models of NICU care. We suggest directions for future research and model implementation to improve and scale-up parent partnership in the care of NICU infants.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California, San Francisco, California
| | - Karel O'Brien
- Department of Paediatrics, Sinai Health System, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
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Ireland S, Ray RA, Larkins S, Woodward L. Perspectives of time: a qualitative study of the experiences of parents of critically ill newborns in the neonatal nursery in North Queensland interviewed several years after the admission. BMJ Open 2019; 9:e026344. [PMID: 31092655 PMCID: PMC6530444 DOI: 10.1136/bmjopen-2018-026344] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
DESIGN A qualitative study informed by grounded theory principles to explore the experiences of parents who had extremely preterm or babies with antenatally diagnosed life-threatening diagnoses who were cared for in a regional tertiary neonatal unit. The study was conducted when the child was old enough to be diagnosed with long-term neurodevelopmental or medical sequelae. SETTING North Queensland is a large area in Eastern Australia of 500 000 km2, which is served by one tertiary neonatal unit. PARTICIPANTS Seventeen families representing 21 extremely preterm babies and one baby with congenital malformations who was not expected to survive prior to delivery (but did) were interviewed using grounded theory principles. Interviews were coded and themes derived. RESULTS Parents who recollect their neonatal experiences from 3 to 7 years after the baby was cared for in the neonatal intensive care described negative themes of grief and loss, guilt and disempowerment. Positive enhancers of care included parental strengths, religion and culture, family supports and neonatal unit practices. Novel findings included that prior pregnancy loss and infertility formed part of the narrative for parents, and hope was engendered by religion for parents who did not usually have a religious faith. CONCLUSIONS An understanding of both the negative aspects of neonatal care and the positive enhancers is necessary to improve the neonatal experience for parents. Parents are able to contextualise their previous neonatal experiences within both the long-term outcome for the child and their own life history.
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Affiliation(s)
- Susan Ireland
- James Cook University College of Medicine and Dentistry, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Robin A Ray
- James Cook University College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - Sarah Larkins
- James Cook University College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - Lynn Woodward
- James Cook University College of Medicine and Dentistry, Townsville, Queensland, Australia
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38
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Weber A, Harrison TM. Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes. Nurs Outlook 2019; 67:169-189. [PMID: 30611546 PMCID: PMC6450772 DOI: 10.1016/j.outlook.2018.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/27/2018] [Accepted: 11/16/2018] [Indexed: 02/08/2023]
Abstract
In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.
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Affiliation(s)
- Ashley Weber
- University of Cincinnati College of Nursing, 310 Proctor Hall, 3110 Vine St, Cincinnati, OH 45221, USA
| | - Tondi M. Harrison
- The Ohio State University, Newton Hall, College of Nursing, 1585 Neil Avenue, Columbus OH, 43210 USA
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Ding X, Zhu L, Zhang R, Wang L, Wang TT, Latour JM. Effects of family-centred care interventions on preterm infants and parents in neonatal intensive care units: A systematic review and meta-analysis of randomised controlled trials. Aust Crit Care 2019; 32:63-75. [PMID: 30554939 DOI: 10.1016/j.aucc.2018.10.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/27/2018] [Accepted: 10/28/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The objective of this study was to review English and Chinese randomised controlled trials (RCTs) to determine the effects of family-centred care (FCC) interventions on preterm infants' and parental outcomes in the neonatal intensive care units and to conduct a meta-analysis. REVIEW METHOD USED Systematic review and meta-analysis. DATA SOURCES Medline, CINAHL, Embase, PsycINFO, BNI, and AMED and the Chinese databases CNKI and Wanfang Data were searched in April 2017 and updated in August 2018. REVIEW METHODS Only RCTs were included. Participants were preterm infants ≤37 weeks gestational age and parents. Interventions were related to FCC, and outcome measures were infant and parent clinical outcomes. Included studies were assessed for risk of bias using Cochrane Manual 5.1.0. Meta-analyses used mean differences (MDs), standardised mean differences (SMDs), or odds ratio (OR), followed by 95% confidence interval (CI). Heterogeneity was tested with Cochran's Q chi-squared test, tau-squared test, and inconsistency index (I2). RESULTS Nineteen studies (10 from English and 9 from Chinese databases) were included; meta-analysis included 15 studies (7 English and 8 Chinese RCTs). Meta-analysis showed significant improvements in weight gain (7 studies: MD, 4.57; 95% CI, 2.80-6.34; P < 0.001; I2 94%); readmission (3 studies: OR, 0.23; 95% CI, 0.10-0.52; P < 0.001; I2 = 0%); parent satisfaction (5 studies: OR, 11.20; 95% CI, 4.76-26.34; p < 0.001; I2 = 0%); skills of parents (4 studies: SMD, 2.57; 95% CI, 2.19-2.96; P < 0.001; I2 = 53%); knowledge of parents (4 studies: SMD, 2.74; 95% CI, 2.47-3.00; P < 0.001; I2 = 0%); parental anxiety at follow-up (3 studies: SMD, -0.19; 95% CI, -0.28 to -0.09; P < 0.001; I2 = 0%); parent depression at follow-up (2 studies: SMD, 0.37; 95% CI, -0.63 to -0.12; P = 0.004; I2 = 44%); and parental stress (3 studies: MD, -0.20; 95% CI, -0.26 to -0.13; P < 0.001; I2 = 0%). No statistical differences were observed in neurobehavioural development (3 studies) and hospital length of stay (7 studies). CONCLUSIONS FCC interventions can improve weight gain and readmission in preterm infants as well as parent satisfaction, knowledge, and skills, and possibly long-term anxiety, depression, and stress. Developing standardised outcome sets for testing family-centred care interventions is recommended.
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Affiliation(s)
- Xiang Ding
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Lihui Zhu
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Rong Zhang
- Neonatal Intensive Care Unit, Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Li Wang
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Ting-Ting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, People's Republic of China.
| | - Jos M Latour
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China; School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK.
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Chellani H, Mittal P, Arya S. Mother-Neonatal Intensive Care Unit (M-NICU): A Novel Concept in Newborn Care. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1436-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Amorim M, Alves E, Kelly-Irving M, Ribeiro AI, Silva S. Quality of life of parents of very preterm infants 4 months after birth: a mixed methods study. Health Qual Life Outcomes 2018; 16:178. [PMID: 30200971 PMCID: PMC6131838 DOI: 10.1186/s12955-018-1011-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/04/2018] [Indexed: 11/14/2022] Open
Abstract
Background Knowledge about parental quality of life (QoL) is paramount to family-centred and integrated healthcare on prematurity, but evidence is limited. We aimed to explore mothers’ and fathers’ perspectives about their QoL 4 months after a very preterm childbirth. Methods This is a cross-sectional mixed methods study using a convergent design. Parents of very preterm infants were systematically recruited at all level III neonatal intensive care units in the Northern health region of Portugal for one year. Four months after childbirth, 61 mothers and 56 fathers filled-in the World Health Organization Quality of Life – BREF Inventory, and 26 couples were interviewed. Linear regression models were computed to assess the association between participants’ characteristics and the QoL. Qualitative data were thematically analysed. Results A quantitative analysis revealed that the perception of QoL was not significantly different by gender. QoL scores increased slightly from the environment (Mean (SD): 72.1 (14.2)) to the psychological domains (Mean (SD): 78.7 (14.4)). All scores were influenced by psychological characteristics. Socioeconomic position influenced both parents’ perceptions concerning the environment domain, and maternal physical and psychological QoL. Infant-related factors were associated with overall QoL among women and with the physical, psychological, social and environment domains among men. Qualitative findings indicated accommodation mechanisms that intertwine the focus on constraining factors (surveillance, sleep disturbances, non-supportive healthcare policies, hygienization) with facilitating factors (social support, accessibility/quality of healthcare, opportunities for developing parental skills). These processes were anchored in child-centredness and a framework that construct hierarchies of hope and expectations about infant’s health and development. Conclusions To capture parental QoL using mixed methods raises awareness for developing intersectoral family-centred policies, integrated health services and focused-interventions to decrease the disempowering effects of surveillance and hygienization.
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Affiliation(s)
- Mariana Amorim
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal. .,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal. .,Global Public Health Doctoral Programme, Porto, Portugal.
| | - Elisabete Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal
| | - Michelle Kelly-Irving
- INSERM UMR1027, F-31000, Toulouse, France.,Université Toulouse III Paul Sabatier, UMR1027, F-31000, Toulouse, France
| | - Ana Isabel Ribeiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal
| | - Susana Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal
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Woodhart L, Goldstone J, Hartz D. The stories of women who are transferred due to threat of preterm birth. Women Birth 2018; 31:307-312. [DOI: 10.1016/j.wombi.2017.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/25/2022]
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Involvement of Parents in the Care of Preterm Infants: A Pilot Study Evaluating a Family-Centered Care Intervention in a Chinese Neonatal ICU. Pediatr Crit Care Med 2018; 19:741-747. [PMID: 29781955 DOI: 10.1097/pcc.0000000000001586] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effectiveness and safety of a family-centered care intervention in a Chinese neonatal ICU. DESIGN Pilot study using a randomized controlled trial design to inform a main randomized controlled trial study. SETTING Stand-alone tertiary children's hospital in China with a 60-bed neonatal ICU serving as a regional neonatal ICU center. PATIENTS Premature infants (n = 61) and their parents (n = 110). INTERVENTIONS Parent education program followed by parents' participation in care as primary caregiver until discharge for a minimum of 4 hours per day. MEASUREMENTS AND MAIN RESULTS Primary outcomes were infants' weight gain at discharge, length of stay, and readmission. Parental outcomes were stress, anxiety, satisfaction, and clinical knowledge. Infants in family-centered care group (n = 31) had higher weight gain (886g vs 542g; p = 0.013), less neonatal ICU length of stay in days (43 vs 46; p = 0.937), and decreased readmission rate at 1 week (41.9 vs 70.0; p = 0.045) and at 1 month (6.5% vs 50%; p < 0.001) compared with the control group (n = 30). Total Mean Parental Stress and Anxiety scores were lower in the family-centered care group (42 vs 59; p ≤ 0.007), mean satisfaction rates in family-centered care group were higher compared with control group (96 vs 90; p < 0.001), and parents in the family-centered care group had better educational outcomes related to neonatal specialized care skills (p < 0.05). CONCLUSIONS Involving parents in the care of their infant improved clinical outcomes of infants. Family-centered care also contributed to a better understanding of parent's clinical education, decrease stress levels, and increased parental satisfaction. Our study suggests that involving parents in the daily care of their infants is feasible and should be promoted by neonatal ICU clinicians.
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Ferraresi MF, Arrais ADR. Evaluation of the Multidisciplinary Assistance provided in a Public Neonatal Care Unit from mothers` perception. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: this study aimed to investigate the evaluation of mothers about the care provided by the multidisciplinary team in a Public Neonatal Care Unit located in the Federal District/Brazil. Methods: this is a descriptive, quantitative and cross-sectional study. The sample consisted of 57 mothers and data were collected from April to September 2015. The instrument used for data collection was a questionnaire with questions distributed in three main domains, such as accessibility and accommodation; communication and relationship with the team and assistance received. Results: the result showed an association of mothers’ satisfaction with the variables “income” and “length of hospital stay”, and demonstrated that the majority of the mothers evaluated the unit positively. However, it was highlighted the need to improve communication between neonatal staff and mothers, and to implement a more flexible visiting policy in order to allow the presence of other family members in the mentioned Unit more frequently. Conclusions: data obtained from this research may contribute to improve the quality of care in the NICUs, in view of the importance of evaluation of assistance so that better care to mothers is available.
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Abstract
Purpose
The purpose of this paper is to explore how nurses make decisions to ration care or leave it undone within a clinical environment that is controlled by systems level cost containment. The authors wanted to find out what professional, personal and organisational factors contribute to that decision-making process. This work follows previous international research that explored missed nursing care using Kalisch and Williams’ MISSCARE survey.
Design/methodology/approach
The authors drew on the care elements used by Kalisch and Williams, asking nurses to tell us how they decided what care to leave out, the conduits for which could include delaying care during a shift, delegating care to another health professional on the same shift, handing care over to staff on the next shift or leaving care undone.
Findings
The findings suggest that nurses do not readily consider their accountability when deciding what care to leave or delay, instead their priorities focus on the patient and the organisation, the outcomes for which are frequently achieved by completing work after a shift.
Originality/value
The actions of nurses implicitly rationing care is largely hidden from view, the consequences for which potentially have far reaching effects to the nurses and the patients. This paper raised awareness to hidden issues facing nurses within a cycle of implicitly rationing care, caught between wanting to provide care to their patients, meeting the organisation’s directives and ensuring professional safety. Rethinking how care is measured to reflect its unpredictable nature is essential.
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Gale C. Family Integrated Care for very preterm infants: evidence for a practice that seems self-evident? THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:230-231. [DOI: 10.1016/s2352-4642(18)30038-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 11/28/2022]
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47
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Venkataraman R, Kamaluddeen M, Amin H, Lodha A. Is Less Noise, Light and Parental/Caregiver Stress in the Neonatal Intensive Care Unit Better for Neonates? Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1220-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
In utero sensory stimuli and interaction with the environment strongly influence early phases of fetal and infant development. Extremely premature infants are subjected to noxious procedures and routine monitoring, in addition to exposure to excessive light and noise, which disturb the natural sleep cycle and induce stress. Non-invasive ventilation, measures to prevent sepsis, and human milk feeding improve short-term and long-term neurodevelopmental outcomes in premature infants. To preserve brain function, and to improve quality of life and long-term neurodevelopmental outcomes, the focus now is on the neonatal intensive care unit (NICU) environment and its impact on the infant during hospital stay. The objectives of this write-up are to understand the effects of environmental factors, including lighting and noise in the NICU, on sensory development of the infant, the need to decrease parental and caregiver stress, and to review existing literature, local policies and recommendations.
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Abstract
PURPOSE Today's social support systems for parents of preterm infants tend to pay more attention to mothers than fathers. As a father also plays a critical role in caring for a preterm infant, there is a need to advance understanding of paternal concerns and needs about social supports that should better support fathers. DESIGN AND METHODS Interviews were conducted with 18 parents of preterm infants (i.e., 10 mothers and 8 fathers) who have been discharged from the NICU to home. All interviews were audio-recorded and subsequently transcribed verbatim for analysis. RESULTS The fathers' primary resources are healthcare professionals, their partners, and peer fathers of preterm infants. The fathers expressed various social support needs associated with informational, belonging, and emotional supports. CONCLUSIONS It is recommended that a social support system be customized accordingly to better accommodate paternal needs. PRACTICE IMPLICATIONS Healthcare professionals may refer to the study results in designing the educational materials for fathers of preterm infants.
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Affiliation(s)
- Hyung Nam Kim
- Department of Industrial and Systems Engineering, North Carolina A&T State University, Greensboro, USA.
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Lean RE, Rogers CE, Paul RA, Gerstein ED. NICU Hospitalization: Long-Term Implications on Parenting and Child Behaviors. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2018; 4:49-69. [PMID: 29881666 PMCID: PMC5986282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW Parents of infants admitted to the Neonatal Intensive Care Unit (NICU) experience psychological distress, loss of the parenting role, and disruptions to parent-infant bonding. The inclusion of evidence-based practices to address these challenges in the NICU has largely been based upon short-term improvements in parent and infant functioning. However, less is known regarding the extent to which family-based interventions may also be associated with longer-term parenting behaviors and children's neurobehavioral outcomes. RECENT FINDINGS Comprehensive family-based NICU interventions demonstrate consistent links with later parental mental wellbeing, sensitive parenting behaviors, and children's cognitive and socioemotional development. Dyadic co-regulation activities implemented inconsistently and/or in isolation to other components of NICU interventions show mixed associations with outcomes, highlighting the need for multifaceted wrap-around care. Further research is needed to delineate associations between NICU interventions and children's neurological and language development, with follow-up beyond very early childhood in larger samples. SUMMARY Long-term associations may reflect the stability of early parental responses to NICU interventions and the extent to which parents continue to implement mental health and sensitive parenting techniques in the home. However, the transition of parental psychiatric care from hospital to community-based services upon NICU discharge remains a pertinent need for high-risk families. Remaining issues also concern the extent to which NICU interventions incorporate sociodemographic differences across families, and whether interventions are generalizable or feasible across hospitals. Despite variation across interventions and NICUs; supporting, educating, and partnering with parents is crucial to strengthen longer-term family functioning and alter the developmental trajectories of high-risk infants.
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Affiliation(s)
- Rachel E Lean
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St. Louis, MO 63110, USA
| | - Cynthia E Rogers
- Department of Pediatrics and Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St. Louis, MO 63110, USA
| | - Rachel A Paul
- Department of Obstetrics and Gynecology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8219, St. Louis, MO 63110, USA
| | - Emily D Gerstein
- Department of Psychological Sciences, University of Missouri- St. Louis, 1 University Blvd, St. Louis, MO 63118, USA. Phone 314-516-5398
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50
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O'Brien K, Robson K, Bracht M, Cruz M, Lui K, Alvaro R, da Silva O, Monterrosa L, Narvey M, Ng E, Soraisham A, Ye XY, Mirea L, Tarnow-Mordi W, Lee SK. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:245-254. [PMID: 30169298 DOI: 10.1016/s2352-4642(18)30039-7] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite evidence suggesting that parent involvement was beneficial for infant and parent outcomes, the Family Integrated Care (FICare) programme was one of the first pragmatic approaches to enable parents to become primary caregivers in the neonatal intensive care unit (NICU). We aimed to analyse the effect of FICare on infant and parent outcomes, safety, and resource use. METHODS In this multicentre, cluster-randomised controlled trial, we stratified 26 tertiary NICUs from Canada, Australia, and New Zealand by country and size, and assigned them, using a computer-generated random allocation sequence, to provide FICare or standard NICU care. Eligible infants were born at 33 weeks' gestation or earlier, and had no or low-level respiratory support; parents gave written informed consent for enrolment. To be eligible, parents in the FICare group had to commit to be present for at least 6 h a day, attend educational sessions, and actively care for their infant. The primary outcome, analysed at the individual level, was infant weight gain at day 21 after enrolment. Secondary outcomes were weight gain velocity, high frequency breastfeeding (≥6 times a day) at hospital discharge, parental stress and anxiety at enrolment and day 21, NICU mortality and major neonatal morbidities, safety, and resource use (including duration of oxygen therapy and hospital stay). This trial is registered with ClinicalTrials.gov, number NCT01852695. FINDINGS From Oct 1, 2012, 26 sites were randomly assigned to provide FICare (n=14) or standard care (n=12). One site assigned to FICare discontinued because of poor site enrolment. Parents and infants were enrolled between April 1, 2013, and Aug 31, 2015, with 895 infants being eligible in the FICare group and 891 in the standard care group. At day 21, weight gain was greater in the FICare group than in the standard care group (mean change in Z scores -0·071 [SD 0·42] vs -0·155 [0·42]; p<0·0002). Average daily weight gain was significantly higher in infants receiving FICare than those receiving standard care (mean daily weight gain 26·7 g [SD 9·4] vs 24·8 g [9·5]; p<0·0001). The high-frequency exclusive breastmilk feeding rate at discharge was higher for infants in the FICare group (279 [70%] of 396) than those in the standard care group (394 [63%] of 624; p=0·016). At day 21, parents in the FICare group had lower mean stress scores than did parents in the standard care group (2·3 [SD 0·8] vs 2·5 [0·8]; p<0·00043), and lower mean anxiety scores (70·8 [20·1] vs 74·2 [19·9]; p=0·0045). There were no significant differences between groups in the rates of the secondary outcomes of mortality, major morbidity, duration of oxygen therapy, and duration of hospital stay. Although the safety assessment was not completed, there were no adverse events. INTERPRETATION FICare improved infant weight gain, decreased parent stress and anxiety, and increased high-frequency exclusive breastmilk feeding at discharge, which together suggest that FICare is an important advancement in neonatal care. Further research is required to examine if these results translate into better long-term outcomes for families. FUNDING Canadian Institutes of Health Research Partnerships for Health System Improvement, and Ontario Ministry of Health and Long-Term Care.
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Affiliation(s)
- Karel O'Brien
- Department of Paediatrics, Sinai Health System, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Kate Robson
- Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Marianne Bracht
- Department of Paediatrics, Sinai Health System, Toronto, ON, Canada
| | - Melinda Cruz
- Miracle Babies Foundation, Chipping Norton, NSW, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ruben Alvaro
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Orlando da Silva
- Department of Paediatrics, Western University, London, ON, Canada
| | - Luis Monterrosa
- Department of Pediatrics, Neonatal Division, Dalhousie University, Halifax, NS, Canada
| | - Michael Narvey
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Eugene Ng
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Amuchou Soraisham
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Lucia Mirea
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Phoenix Children's Hospital, Phoenix, AZ, USA
| | - William Tarnow-Mordi
- WINNER Centre for Newborn Research, NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Shoo K Lee
- Department of Paediatrics, Sinai Health System, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
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