Abstract
BackgroundWe have developed a Family Integrated Care (FIC) model for use in a neonatal intensive care unit (NICU) where parents provide most of the care for their infant, while nurses teach and counsel parents. The objective of this pilot prospective cohort analytic study was to explore the feasibility, safety, and potential outcomes of implementing this model in a Canadian NICU.MethodsInfants born ≤35 weeks gestation, receiving continuous positive airway pressure or less respiratory support, with a primary caregiver willing and able to spend ≥8 hours a day with their infant were eligible. Families attended daily education sessions and were mentored at the bedside by nurses. The primary outcome was weight gain, as measured by change in z-score for weight 21 days after enrolment. For each enrolled infant, we identified two matched controls from the previous year’s clinical database. Differences in weight gain between the two groups were analyzed using a linear mixed effects multivariable regression model. We also measured parental stress levels using the Parental Stress Survey: NICU, and interviewed parents and nurses regarding their experiences with FIC.ResultsThis study included 42 mothers and their infants. Of the enrolled infants, matched control data were available for 31 who completed the study. The rate of change in weight gain was significantly higher in FIC infants compared with control infants (p < 0.05). There was also a significant increase in the incidence of breastfeeding at discharge (82.1 vs. 45.5%, p < 0.05). The mean Parental Stress Survey: NICU score for FIC mothers was 3.06 ± 0.12 at enrolment, which decreased significantly to 2.30 ± 0.13 at discharge (p < 0.05). Feedback from the parents and nurses indicated that FIC was feasible and appropriately implemented.ConclusionsThis study suggests that the FIC model is feasible and safe in a Canadian healthcare setting and results in improved weight gain among preterm infants. In addition, this innovation has the potential to improve other short and long-term infant and family outcomes. A multi-centre randomized controlled trial is needed to further evaluate the efficacy of FIC in the Canadian context.
Highlights
We have developed a Family Integrated Care (FIC) model for use in a neonatal intensive care unit (NICU) where parents provide most of the care for their infant, while nurses teach and counsel parents
Study recruitment and ethics Infants admitted to the NICU between 1st March, 2011 and 30th April, 2012 were eligible to participate in the study when they became stable on continuous positive airway pressure (CPAP) or required less respiratory support, and were receiving greater than 50% of their fluid requirements as enteral feeds
Following admission to the NICU, as infants became eligible their parents were provided with an information package about the FIC study and approached to consent to, and complete a Parental Stress Scale: Neonatal Intensive Care Unit (PSS-NICU) questionnaire
Summary
We have developed a Family Integrated Care (FIC) model for use in a neonatal intensive care unit (NICU) where parents provide most of the care for their infant, while nurses teach and counsel parents. In the highly technological environment of the modern neonatal intensive care unit (NICU), infants are physically, psychologically, and emotionally separated from their parents. To address this issue, many programs, such as kangaroo care, skin-to-skin care, and family-centred care, encourage greater parent involvement [1,2,3]. In another review of interventions for preterm infants included in this supplement, Benzies et al, suggest that providing psychosocial supports for parents may have the greatest long term benefits for families [7]
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