NeoNotes
Journal Club
Andrew B. Kairalla MD, Editor
Reviewed by: Joanna Celenza
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OBJECTIVES
Parental involvement in the care of preterm infants in NICUs is becoming
increasingly common, but little is known about its effect on infants'
length of hospital stay and infant morbidity. Our goal was to evaluate
the effect of a new model of family care (FC) in a level 2 NICU, where
parents could stay 24 hours/day from admission to discharge.
METHODS
A randomized, controlled trial was conducted in two NICUs (both level
2), including a standard care (SC) ward and an FC ward, where parents
could stay from infant admission to discharge. In total, 366 infants
born before 37 weeks of gestation were randomly assigned to FC or SC on
admission. The primary outcome was total length of hospital stay, and
the secondary outcome was short-term infant morbidity. The analyses were
adjusted for maternal ethnic background, gestational age, and hospital
site.
RESULTS
Total length of hospital stay was reduced by 5.3 days: from a mean of
32.8 days (95% confidence interval [CI]: 29.6–35.9) in SC to 27.4 days
(95% CI: 23.2–31.7) in FC (P = .05). This difference was mainly related
to the period of intensive care. No statistical differences were
observed in infant morbidity, except for a reduced risk of
moderate-to-severe bronchopulmonary dysplasia: 1.6% in the FC group
compared with 6.0% in the SC group (adjusted odds ratio: 0.18 [95% CI:
0.04–0.8]).
CONCLUSIONS
Providing facilities for parents to stay in the neonatal unit from
admission to discharge may reduce the total length of stay for infants
born prematurely. The reduced risk of moderate-to-severe
bronchopulmonary dysplasia needs additional investigation.
COMMENTS
Family-centered care is evolving from being considered the right thing
for health care institutions to embrace, to an integral movement within
healthcare improvement to meaningfully partner with families. These
partnerships can lead to improvements including reduced length of stay,
as this study specifically suggests. Studies such as this add to the
body of evidence that family participation in care can be linked to
decreased length of stay in the neonatal intensive care environment.
This study underscores the importance of providing the environment where
the parents can quickly assume the role of primary caregiver from
admission to discharge. Findings suggesting that parental involvement
can directly impact pulmonary morbidity and other clinical outcomes,
warrant additional attention and research.
This particular randomized controlled study in two Level II Neonatal
Intensive Care Units in Sweden compares a FC unit to a SC unit with
identical medical guidelines and nursing practices. It is worth noting
that the FC unit provides space for parents to stay with their baby 24/7
from admission through discharge. The SC unit does not provide
facilities for parents to stay overnight consistently, however it is
worth noting that parents were encouraged to spend as much time with
their infant as possible. They were not limited by policies restricting
families’ presence on the unit that continue to be the norm in many
neonatal intensive care units today.
The
toolkit for the Design and Build group contains a PBP
related to creating space that is conducive to facilitating the parents
having a primary role in the care of the infant throughout the stay.
An
additional article cited as a reference in the toolkit
is one that relates more to parents' satisfaction than to clinical
outcomes and highlights the advantages to having private rooms. The
article, "Families' views upon experiencing change in the neonatal
intensive care unit environment: From the 'baby barn' to the private
room" found the added developmental advantages of private space were a
key component to parents' increased satisfaction.
A growing body of evidence suggests that maintaining, supporting, and
sustaining the relationship between parents and their infant throughout
the entire stay, from admission to discharge, improves the health and
outcomes of these babies. The design of neonatal intensive care units
plays a critical role in enhancing and supporting these interactions. It
would be advantageous to have additional studies that include measures
beyond parental satisfaction and length of stay such as long-term
developmental outcomes, reductions in BPD and CLD and other morbidities.
Joanna Celenza
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