Breastfeeding outcomes in family integrated care model in neonatal intensive care units

Abstract

Objective To understand the influence of family integrated care (FICare) model to the human breastfeeding rate of preterm infants in neonatal intensive care units (NICUs). Method It is a multicenter cluster randomized controlled trail for intervention and prognosis. According to inclusion and exclusion criteria, preterm infants with gestation age 28~35 weeks in 9 NICUs of tertiary hospitals in 8 provinces in China were enrolled and divided into FICare and control group. Mothers of FICare infants were invited to stay in NICU ward at bedside for no less than 3 hours per day. Under the supervision of nurses, FICare infants′mothers complete 13 items of infants′caring skills including Six-step Hand Washing and hand hygiene, positioning the baby, changing diapers and estimating urine output, skin and mouth caring, kangaroo care and so on. The primary outcome is the human breastfeeding rate. Secondary outcomes include feeding parameters and FICare-related parameters. SPSS 20.0 software is used for the data analysis. Result (1) There were 212 infants and 215 infants enrolled in FICare group and control group, respectively. There was no significant difference between 2 groups in gender, gestational age, birth weight (BW), Z-score of BW, singleton percentage, antenatal steroid completion, diagnosis, day of life (DOL) for starting feeds (P>0.05). (2) There was no significant difference between 2 groups in DOL for full feeding (P>0.05). The median age of starting breastfed in both groups was DOL 4. There were 202 cases (87.3%) in FICare group and 80 cases (34.9%) in control group be successfully breastfed. The rate of formula feeding, incidence of nosocomial infection, DOL for regaining BW, decrease of BW ΔZ score in FICare group was significantly lower than the control group, and the weight gain velocity after regaining BW in FICare group was significantly higher than the control group (P<0.05). (3) The implementation of FICare and completion of antenatal steroid were the independent protective factors for breastfeeding (OR=27.703, 95% CI 14.531~52.816; OR=9.496, 95% CI 4.768~18.912), while nosocomial infection and delayed DOL for starting breastfeeding were the independent risk factors for breastfeeding (OR=0.380, 95%CI 0.182~0.795; OR=0.847, 95%CI 0.734~0.977). Conclusion FICare is significantly beneficial to the breastfeeding rate of preterm infants in NICUs. FICare may decrease the severity of extra-uterine growth retardation. Key words: Intensive care units, neonatal; Infant, premature; Breast feeding; Family integrated care; Outcome