A report from Mount Sinai hospital in Toronto of an innovative program to integrate parents much more into the day to day care of babies in the NICU. (O’Brien K, Bracht M, Macdonell K, McBride T, Robson K, O’Leary L, Christie K, Galarza M, Dicky T, Levin A et al: A pilot cohort analytic study of family integrated care in a canadian neonatal intensive care unit. BMC Pregnancy and Childbirth 2013, 13(Suppl 1):S12.) Free access to full text.This is a pilot study performed as a prospective case-control design. Babies who were no longer ventilated, but could be stable on CPAP, and had more than 50% of their feeds enterally were eligible if a parent was available to spend at least 8 hours a day in the NICU.
There was a fairly intensive educational intervention, and the parents took over a lot of the things that are currently usually done by the nurses, for 8 hours a day between the hours of 7 am and 8 pm.
‘Parents were also expected to provide care for their infant(s), especially in the areas of feeding, bathing, dressing, holding, and providing skin-to-skin care, perform basic charting, and maintain a record of their own learning regarding their proficiency in providing care for their infant(s) in the NICU. Nurses remained responsible for more technical aspects of the infant’s care, such as insertion of nasogastric catheters, placement of CPAP prongs, oral suctioning, and adjustment of oxygen concentrations.’
The primary outcome of this pilot was to a measure of growth, the change in the z score between enrollment and 21 days. It was a little better in the Family Integrated Care Infants, but not significantly. Among the other outcomes they examined, there were many more mothers breastfeeding at discharge, and perhaps fewer nosocomial infections, less retinopathy and fewer reports of adverse incidents.
Now this isn’t the most rigorous design, but I think it was appropriate for this pilot project, and it certainly suggests that integrating families more into the care of their babies may have substantial benefits on short term outcomes.
I asked Katharina Staub, a parent representative who is founder and president of the Canadian Premature Babies Foundation to comment:
As a parent of premature twins born at 27 weeks in 2008, I can only applaud this type of approach to the care of premature infants.
Having spoken to one of the mothers who participated in this initial study, it was clear that her participation in the study made for a very positive experience in the NICU. Her anxiety was reduced because of her extensive involvement in the daily care of her baby.
For parents it is empowering to be supported by the staff in the training of how to take care of your baby in the NICU. It gives you confidence to be part of the healing of their child.
What most parents view as normal with a full term child, the act of parenting, feeding, caring for the infant is not so easy in the NICU. This type of care gives a great basis for bonding with your child. It will be interesting to see the results of the Canada wide study that has started in 16 centres.
Katharina Staub Canadian Premature Babies Foundation.