No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Parents, siblings and grandparents in the Neonatal Intensive Care Unit. A survey of policies in eight European countries
Abstract
To describe policies towards family visiting in Neonatal Intensive Care Units (NICU) and compare findings with those of a survey carried out 10 years earlier.
A questionnaire on early developmental care practices was mailed to 362 units in eight European countries (Sweden, Denmark, the UK, the Netherlands, Belgium, France, Spain and Italy). Of them 78% responded, and among those responded, 175 reported caring for at least 50 very low birth weight infants every year and their responses were analysed further.
A majority of all units allowed access at any time for both parents. This was almost universal in northern Europe and the UK, whereas it was the policy of less than one-third of NICU in Spain and Italy, with France in an intermediate position. Restrictions on visiting of grandparents, siblings and friends, as well as restricting parents' presence during medical rounds and procedures followed the same pattern. A composite visiting score was computed using all the variables related to family visiting. Lower median values and larger variability were obtained for the southern countries, indicating more restrictive attitudes and lack of national policy.
The presence of parents and other family members in European NICUs has improved over a 10-year period. Several barriers, however, are still in place, particularly in the South European countries.
... A few of the studies dedicated to DC in Italian NICUs were performed during the last two decades [8][9][10][11][12][13], but some of them were focused on specific aspects of the DC theme. The 2009 de Vonderweid U. and Leonessa M [9] study was very brief and general and reported open NICU access to mothers in only 29% of Italian NICUs; the questionnaire used in the study was not reported. ...
... A few of the studies dedicated to DC in Italian NICUs were performed during the last two decades [8][9][10][11][12][13], but some of them were focused on specific aspects of the DC theme. The 2009 de Vonderweid U. and Leonessa M [9] study was very brief and general and reported open NICU access to mothers in only 29% of Italian NICUs; the questionnaire used in the study was not reported. A European study by Greisen et al. (2009) [8] compared parental involvement and KMC in eight European countries. ...
... The 2009 de Vonderweid U. and Leonessa M [9] study was very brief and general and reported open NICU access to mothers in only 29% of Italian NICUs; the questionnaire used in the study was not reported. A European study by Greisen et al. (2009) [8] compared parental involvement and KMC in eight European countries. The study, conducted between 2004 and 2006 by a European network sponsored by the European Science Foundation [8], was based on a questionnaire on early DC practises that was mailed to 362 units in eight European countries. ...
Background
Studies on the application of developmental care initiatives in Italian NICUs are rather scarce. We aimed to assess parental access to the NICUs and facilities offered to the family members and to test “the state of art” regarding kangaroo mother care (KMC) and breastfeeding policies in level III Italian NICUs.
Methods
A questionnaire both in paper and in electronic format was sent to all 106 Italian level III NICUs; 86 NICUs (i.e., 80% of NICUs) were completed and returned.
The collected data were analysed. In addition, a comparison between the 2017 survey results and those of two previous surveys conducted from 2001 to 2006 was performed.
Results
In total, 53 NICUs (62%) reported 24-h open access for both parents (vs. 35% in 2001 and 32% in 2006). Parents were requested to temporarily leave the unit during shift changes, emergencies and medical rounds in 55 NICUs (64%). Some parental amenities, such as an armchair next to the crib (81 units (94%)), a room for pumping milk and a waiting room, were common, but others, such as family rooms (19 units (22%)) and adjoining accommodation (30 units (35%)), were not. KMC was practised in 81 (94%) units, but in 72 (62%), i.e., the majority of units, KMC was limited to specific times. In 11 (13%) NICUs, KMC was not offered to the father. The average duration of a KMC session, based on unit staff estimation, was longer in 24-h access NICUs than in limited-access NICUs. KMC documentation in medical records was reported in only 59% of questionnaires. Breastfeeding was successful in a small proportion of preterm infants staying in the NICU.
Conclusion
The number of 24-h access NICUs doubled over a period of 13 years. Some basic family facilities, such as a dedicated kitchen, rooms with dedicated beds and showers for the parents, remain uncommon. KMC and breastfeeding have become routine practices; however, the frequency and duration of KMC sessions reported by NICU professionals still do not meet the WHO recommendations.
... [5][6][7] The proportion of NICUs that enable parents to stay day and night for the whole of the hospital stay is probably low globally and varies greatly within and between countries. Greisen et al 8 showed that the percentage of parents who could spend the night in participating units during [2004][2005][2006] ranged from 14% in Spain to 78% in Sweden. ...
... Few studies have been conducted on the involvement and influence of significant others in the NICU setting. Greisen et al 8 showed that most of the participating units in Denmark, the UK, the Netherlands and Belgium allowed siblings, grandparents and friends to visit. The participating NICUs in Sweden were much more restrictive towards visits by extended family. ...
... McHaffie's 28 findings on what parents want from grandparents showed that the three top appropriate roles for grandparents were perceived to be: (a) supporting the parents emotionally, (b) visiting the baby and (c) establishing a relationship with the baby themselves. As shown by our study, as well as the study by Greisen et al,8 few neonatal units allow grandparents or friends into the units without restrictions (eg accompanied by parents or with staff agreement). This is a cause for concern. ...
Aim:
To describe parental facilities for staying in neonatal units, visiting policies, and access to emotional support during hospitalization.
Methods:
A cross-sectional design was used in which a survey was presented to all neonatal units in Sweden; 34 out of 38 units participated (89%).
Results:
The findings showed that in 50% of the units, parents could stay 24/7 for the infant's entire hospital stay. In 32% of the units, siblings could stay the night with their parents. Units had policies on restrictions for visits by siblings (80%), grandparents (59%), friends and relatives (71%). All units offered counselling to parents, and some units offered peer-to-peer groups (24%), diaries (35%), relaxation techniques (6%) or internet parental forums (6%). All units enabled parents to be at home with their infant and to visit the unit for check-ups (35%) or to have staff visits at home (65%).
Conclusion:
Facilities for parents to stay with their infant during hospitalization and to have significant others visit are good, but there is room for improvement. During the transitional phase to being at home, parents are facilitated in being at home before the infant is discharged and are supported by the unit, which must be considered beneficial for parents. This article is protected by copyright. All rights reserved.
... The parents' need for open communication is not always met by the NICU staff (Wigert & Dellenmark, 2013), and cooperation, collaboration, and negotiated care with shared decisionmaking are not always evident in the care provided to premature infants and their families (Hutchfield, 1999;Mikkelsen & Frederiksen, 2011). Accordingly, a change in the roles and attitudes of the NICU staff is required to facilitate a successful partnership (Greisen et al., 2009). ...
... All rights reserved. substantial progress has occurred towards the unrestricted presence of parents and other relatives in the European NICUs (Greisen et al., 2009), although this is not the policy worldwide. Even with unrestricted policies, the parents' presence in NICU varies from a median of 3.3. ...
... Development of evidence-based policies and guidelines is needed to promote FCC, hence the findings from this metasyntheses are relevant and important. When reviewing the policies in NICUs, ways could simultaneously be found to promote the presence of parents and to integrate them into daily life in the units (Greisen et al., 2009), in order to create a partnership and to support them in parenting their premature infants. Nursing leaders are well positioned to realize FCC. ...
Aims and objectives
To explore how parents and nurses experience partnership in neonatal intensive care units (NICU) and to identify existing barriers and facilitators to a successful partnership.
Background
Family‐centered care (FCC) is recommended as a frame of reference for treatment and care in NICUs. A key element in FCC is partnership. Such partnerships are characterised by complex interpersonal relationships and interactions between nurses and parents/families. Partnerships therefore appear to present a significant challenge.
Design
A qualitative review and meta‐synthesis.
Methods
Comprehensive searching in ten databases: Cinahl, Pubmed (MEDLINE), Embase, PsycInfo, Scopus and Swemed+, Opengrey, MedNar, Google Scholar and ProQuest Dissertations & Thesis Global. A total of 1,644 studies (after removal of duplicates) were critically assessed and 21 studies fulfilled the inclusion criteria. A meta‐aggregation was used to synthesise the findings from the studies. Methodically quality assessed with QUARI/SUMARI and PRISMA.
Findings
Through a meta‐aggregative approach two synthesised findings were developed: 1) co‐creation of mutual knowledge and 2) developing competencies and negotiating roles. The first synthesis embraced the categories: being respected and listened to, trust, sharing knowledge, and the second synthesis embraced the categories: space to learn with guidance, encouraging and enabling, being in control. In constructing the categories, findings were identified as characteristics, barriers and facilitators to application.
Conclusion
A successful relationship between parents and nurses can be achieved through co‐creation of mutual knowledge as well as development of competencies and negotiation of roles. Neonatal Intensive Care Unit nurses are in a position where they exercise power, but they can change the culture if they are aware of what seems to facilitate or create a barrier to a partnership with parents.
Relevance to clinical practice
This new evidence may inform a change in policies and guidelines which could be integrated into nurses’ clinical practice in NICUs.
This article is protected by copyright. All rights reserved.
... Many units have, indeed, started to encourage and expect parents' participation in medical rounds [5,14]. However, there are differences in these policies and practices between countries and units [5,[14][15][16][17]. Many units still do not allow parents to be present during medical rounds [15,16]. ...
... However, there are differences in these policies and practices between countries and units [5,[14][15][16][17]. Many units still do not allow parents to be present during medical rounds [15,16]. The obstacles to achieving increased parental presence can include unit policy about parents' visiting, concerns about confidentiality and teaching of trainees, and concerns regarding high levels of noise and light [15,17,18]. ...
... Many units still do not allow parents to be present during medical rounds [15,16]. The obstacles to achieving increased parental presence can include unit policy about parents' visiting, concerns about confidentiality and teaching of trainees, and concerns regarding high levels of noise and light [15,17,18]. Studies report that parents want to attend medical rounds [17,19], but their willingness to participate in decisionmaking varies according to the nature of the decision being made and the condition of the child [5,20]. ...
Background: Parents' involvement during hospital care is beneficial for preterm infants and their parents. Although parents are encouraged to be present in many neonatal intensive care units (NICUs), little is known about their role during medical rounds.
Aims: To study parents' presence in the NICU, the degree of parents' participation during medical rounds, and to identify underlying factors for participation.
Study design and subjects: A prospective study was performed in 11 neonatal units in six European countries including parents of preterm infants born before 35 gestational weeks.
Outcome measures: Parents' presence and the degree of participation (7-point Likert scale) during medical rounds were asked using a text-message question sent to the mobile phone of each parent separately.
Results: A total of 241 families were included in the study; mothers responded to 630 and fathers to 474 text-message questions, respectively. In studied units, mothers were present during medical rounds on 62.5% to 91% and fathers 30.8% to 77.8% of the days. The degree of mothers' and fathers' participation also varied between units (p < 0.001 and p = 0.022, respectively). In multivariate analysis, parents' presence increased by increasing gestational age (p = 0.010), fathers' education (p = 0.009), and by the policy in the unit to invite parents to medical rounds (p = 0.036). The background characteristics did not explain the degree of participation.
Conclusion: There is significant variation between neonatal units in how they include parents in medical rounds. Only few background characteristics explained the differences suggesting that unit culture plays a major role in welcoming parents to participate.
... Furthermore, this analysis illustrates a positive link between parental satisfaction and the existence of unrestricted visiting hours. In 2009, Greisen et al. [41] found different visiting policies in European countries. According to their findings, parents were allowed to visit their infants at any time in NICUs from Sweden, Denmark and the United Kingdom, and in 90% of those in the Netherlands and Belgium, but only in 71% of NICUs in France and about 30% of the Italian and Spanish units. ...
... According to their findings, parents were allowed to visit their infants at any time in NICUs from Sweden, Denmark and the United Kingdom, and in 90% of those in the Netherlands and Belgium, but only in 71% of NICUs in France and about 30% of the Italian and Spanish units. Although this policy has changed within the last few years [41], unlimited access of parents to NICUs and unrestricted parental presence are not yet a uniformly accepted standard among NICUs [41,42]. ...
... According to their findings, parents were allowed to visit their infants at any time in NICUs from Sweden, Denmark and the United Kingdom, and in 90% of those in the Netherlands and Belgium, but only in 71% of NICUs in France and about 30% of the Italian and Spanish units. Although this policy has changed within the last few years [41], unlimited access of parents to NICUs and unrestricted parental presence are not yet a uniformly accepted standard among NICUs [41,42]. ...
Purpose: This study aims to provide insights into the impact of organizational family-centered care characteristics at German neonatal intensive care units (NICUs) on the satisfaction of parents of very low birthweight (VLBW) infants.
Materials and methods: Using multilevel modeling, this study analyzed whether organizational characteristics of NICUs fostering parent–infant interaction (by way of the existence of a recreation room, possibility of rooming in, existence of unrestricted visiting hours for parents, existence of parental classes, and the connection to parent associations as well as the existence of standards on developmentally supportive care) increase the satisfaction of parents after the infants’ high-intensive care phase within the NICU.
Results: Nine hundred and twenty-three VLBW infants from 66 NICUs in Germany born between May and October 2013 were enrolled in this multicenter study. We retrieved 1493 questionnaires completed by 1277 parents. The existence of unrestricted visiting hours (adjusted odds ratio (AOR): 1.967; 95% CI [1.118, 3.459]) and standardized procedures for developmentally supportive care (AOR: 1.775; 95% CI [1.166, 2.704]) were positively associated with parental satisfaction.
Conclusions: Fostering the parent–infant interaction through the provision of developmentally supportive care and unrestricted visiting hours for parents whose infants are hospitalized within an NICU significantly contributes to the satisfaction of parents.
... Current recommendations for infant-and family-centered developmental care strongly support parents being as close as possible to their infants (6) and that separation should be avoided. European studies showed that policies regarding parental presence and involvement in the NICU varied widely among countries and among NICUs within individual countries (28,29). There is greater support for parental presence in the NICU in northern than other European countries. ...
... There is greater support for parental presence in the NICU in northern than other European countries. However, increasing emphases are being placed on applying fewer restrictions for parents regarding access to the NICU, more encouragement for parents to provide skin-to-skin contact, and improved accessibility of parents to bedrooms, family kitchens, and private bathrooms in NICUs (28,30). These changes of NICU policies are essential for successfully promoting a father's physical proximity with their infant. ...
Objectives
We aimed to evaluate (1) fathers’ perceptions and care involvement for their very premature infants and their views of the hospitalization period based on parental reports and (2) their evolution over time.
Methods
We used an online parental survey to assess answers from parents of very preterm infants who were successfully discharged from French neonatal units. We analysed answers from February 2014 to January 2019 to an anonymous internet-based survey from the GREEN committee of the French Neonatal Society. Responses were compared for period 1 (P1, 1998 to 2013) and period 2 (P2, 2014 to 2019).
Results
We analyzed 2,483 surveys, 124 (5%) from fathers and 2,359 (95%) from mothers. At birth, 1,845 (80%) fathers were present in the hospital, but only 879 (38%) were near the mother. The presence of fathers in the NICU increased from P1 to P2 (34.5% vs. 43.1%, p = 0.03). Nearly two thirds of fathers accompanied their infants during transfer to the NICU (1,204 fathers, 60.6%). Fathers and mothers had similar perceptions regarding relationships with caregivers and skin-to-skin contact with their infants. However, more fathers than mothers felt welcome in the NICU and in care involvement regarding requests for their wishes when they met their infant (79% vs. 60%, p = 0.02) and in the presentation of the NICU (91% vs. 76%; p = 0.03). Mothers and fathers significantly differed in the caring procedures they performed (p = 0.01), procedures they did not perform but wanted to perform (p < 0.001), and procedures they did not perform and did not want to perform (p < 0.01).
Conclusion
Most fathers were present at the births of their very preterm infants, but fewer fathers were near the mother at this time. Less than two thirds of fathers accompanied their infants to the NICU. There should be further changes to better meet the specific needs of the fathers of infants requiring care in the NICU. Continuing assessment with an online questionnaire may be useful to monitor changes over time in father’s involvement in NICUs.
... 6 Previous studies have mainly described access policies for families in the NICU, availability of single bed units, compliance with the baby-friendly hospital initiative, and actual parental presence, SSC, or participation in medical rounds. [26][27][28][29][30][31] Other work has focused on the concept, pathways, and feelings of closeness from parents' perspectives, 4,22,32 insights into perceptions and aspirations of highly motivated medical staff to physical closeness 33 and facilitators and barriers for family-centered care from staff employed in hospitals from three European countries. 34 To our knowledge, no data or qualitative analysis is currently available considering facilitators to implement parent-infant closeness and achieve zero-separation in neonatal care covering a vast majority of European countries. ...
... One of the strengths of our study is that we included parents during all phases of conduct and analysis, making the results and challenges that are met meaningful for all stakeholders. Moreover, we have interviewed a large sample throughout Europe, whereas previous studies have focused either on healthcare professionals with high incentives for PPNC models, 33,34 or on quantitative outcomes 26,28,29,33 without addressing an in-depth understanding of the matter of parent-infant separation specifically. ...
Importance:
Parent-infant closeness and active parent participation in neonatal care are important for parent and infant health.
Objective:
To give an overview of current neonatal settings and gain an in-depth understanding of facilitators and barriers to parent-infant closeness, zero-separation, in 19 countries.
Methods:
Neonatal intensive care unit (NICU) professionals, representing 45 NICUs from a range of geographic regions in Europe and Canada, were purposefully selected and interviewed June-December 2018. Thematic analysis was conducted to identify, analyze and report patterns (themes) for parent-infant closeness across the entire series of interviews.
Results:
Parent-infant separation during infant and/or maternity care is very common (42/45 units, 93%), despite the implementation of family integrated care (FICare) practices, including parent participation in medical rounds (17/45, 38%), structured education sessions for parents (16/45, 36%) and structured training for healthcare professionals (22/45, 49%). NICU professionals encountered four main themes with facilitators and barriers for parent-infant closeness on and between the hospital, unit, staff, and family level: Culture (jointly held characteristics, values, thinking and behaviors about parental presence and participation in the unit), Collaboration (the act of working together between and within different levels), Capacities (resources and policies), and Coaching (education to acquire and transfer knowledge and skills).
Interpretation:
Implementing parent-infant closeness in the NICU is still challenging for healthcare professionals. Further optimization in neonatal care towards zero-separation and parent-infant closeness can be achieved by enforcing the 'four Cs for Closeness': Culture, Collaboration, Capacities, and Coaching.
... Επίσης, πολλές χώρες δεν έχουν πετύχει τους στόχους της Διακήρυξης INNOCENTI ενώ αρκετές απ' αυτές δεν διαθέτουν «Φιλικό για το Βρέφος Νοσοκομείο». Επιπρόσθετα, το νομοθετικό πλαίσιο των ευρωπαϊκών χωρών υπολείπεται όσον αφορά τη διαφήμιση και την εμπορία των υποκατάστατων του μητρικού γάλακτος από το Διεθνή Κώδικα ενώ πολλές κατηγορίες εργαζόμενων μητέρων δεν συμμερίζονται τη νομοθεσία για την προστασία της μητρότητας (Greisen et al., 2009 Οφέλη για το νεογνό, βρέφος, μετέπειτα παιδί Ο μητρικός θηλασμός έχει πολλά οφέλη για την σωματική υγεία του βρέφους και την ανάπτυξή του. Ο θηλασμός προστατεύει το βρέφος από γαστρεντερική νόσο, αναπνευστική νόσο, μέση ωτίτιδα και νεκρωτική εντεροκολίτιδα (NEC). ...
Εισαγωγή
Ο μητρικός θηλασμός αποτελεί σπουδαίος σταθμός στη ζωή του ανθρώπου. Η απόφαση μιας μητέρας να θηλάζει το παιδί της εξαρτάται από την καθοδήγηση, εκπαίδευση και υποστήριξη που θα λάβει πριν και αμέσως μετά τον τοκετό και κατά τις πρώτες εβδομάδες του θηλασμού. Ωστόσο, οι προσπάθειες των επαγγελματιών για τη στήριξη του θηλασμού μπορούν να υπονομευθούν από διάφορους παράγοντες, όπως τα νοσοκομειακά στερεότυπα, η ίδια τη μητέρα και τα κοινωνικά εμπόδια.
Σκοπός
Με αυτή τη βιβλιογραφική ανασκόπηση γίνεται μια προσπάθεια εντοπισμού παραγόντων που επηρεάζουν τον μητρικό θηλασμό διδύμων βρεφών, ώστε να ενισχυθεί και παροτρυνθεί η μητέρα να θηλάσει αποκλειστικά τα βρέφη της.
Αποτελέσματα
Οι μητέρες που γεννούν περισσότερα από ένα βρέφη συχνά αντιμετωπίζουν δυσκολίες στην έναρξη του θηλασμού κατά τη διάρκεια της νοσηλείας τους και απαιτούνται κατάλληλες παρεμβάσεις και υποστήριξη. Επιπλέον η γέννηση των διδύμων μωρών είναι σωματικά και ψυχικά πιο δύσκολή σε σύγκριση με τη μονήρη και αυτό αποτελεί παράγοντα κατά της έναρξης του μητρικού θηλασμού.
Συμπεράσματα
Η συστηματική υποστήριξη και εκπαίδευση από τις μαίες θα διασφαλίσουν ότι η μητέρα θα αρχίσει τον θηλασμό και την επαρκή παραγωγή γάλακτος. Τέλος, οι μαίες πρέπει να εντοπίζουν τους παράγοντες που επηρεάζουν τον πρόωρο απογαλακτισμό των δίδυμων
... However, cultural variation limits the opportunities for fathers in some parts of the world, and NICU policies can act as barriers to paternal SSC and participation in infant care. This study illustrates that there are still fathers in Europe that do not feel sufficiently involved in infant care in the NICU (Greisen et al., 2009;SCENE research group, 2016), indicating a need for updated clinical practices with more focus on the father. ...
Problem
Preterm birth is a stressful event. Paternal experiences of having a preterm infant indicate a need for tailored support. However, it is unclear which interventions work best. This review presents the evidence on existing healthcare interventions to support fathers of preterm infants in early parenthood, how effective they are and paternal experiences with the interventions.
Eligibility criteria
The integrative review process of Whittemore and Knafl was used to guide the study. A structured and comprehensive literature search was conducted in PubMed (MEDLINE), Embase, CINAHL, PsycInfo, Cochrane, Scopus, Web of Science, SweMed+, and Proquest Dissertation & Thesis Global.
Sample
A total of 18 qualitative and quantitative studies were included in the review. The Mixed Methods Appraisal Tool was used to assess quality.
Results
Three overall themes were identified in the analysis: 1) Skin-to-skin contact supported interaction between infant and father, 2) information impacted paternal experiences of stress, anxiety, and development of fatherhood, 3) fathers' relationships with the nurses oscillated between conflict and assistance.
Conclusions
Our findings show that targeted interventions could support father-infant interaction and reduce stress among fathers of preterm infants.
Implications
Fathers of preterm infants rely on nurses to support their engagement in early parenthood, while nurses facilitate the interventions that engage the fathers. It is also essential to develop a culture within the neonatal intensive care unit that encourages the presence of fathers and enhances educational nursing strategies for supporting fathers of preterm infants during early parenthood.
... (9) Besides, the participation of the parents is influenced not only by the presence of other children at home, but also by personal limitations such as working time, distance from the hospital, and travel expenses. (10) In this way, the parents, especially the mother, are the axis around which the various strategies aimed at promoting the achievement of better care, development, and a better quality of life in the future of newborns and their families are developed. This is encompassed by family-centered care (FCC), an approach to medical care that is based on the association of patients, families, and health professionals whose objective is to empower the patient's family by promoting direct participation in their care. ...
Objective: To analyze the importance of visits by sisters and brothers of newborns hospitalized in Neonatology Units from the experiences reported in the literature. Methods: To provide a reflection on the experiences in the world, a review of articles containing the theme of siblings is carried out, selected for the breadth of the study, whether it is quantitative, qualitative or mixed experience. Conclusion: The importance of the implementation of sibling visits in the various hospital centers lies in its detection as a fundamental factor that reduces parental and family stress, improving the bonds between siblings and communication within the family. The impediments lie in the risk of transmission of microorganisms to patients who have an immature or weakened immune system, together with the internal policies of many centers, which prevent the entry of young children as visitors. Resumo Objetivo: Analisar a importância das visitas de irmãos de recém-nascidos internados em Unidades de Neonatologia a partir das experiências relatadas na literatura. Métodos: Para proporcionar uma reflexão sobre as experiências no mundo, é realizada uma revisão de artigos que contenham a temática dos irmãos, selecionados pela amplitude do estudo, seja quantitativo, qualitativo ou experiência mista. Conclusão: A importância da implementação da visita de irmãos nos diversos centros hospitalares reside na sua detecção como fator fundamental para a redução do estresse parental e familiar, melhorando o vínculo entre os irmãos e a comunicação dentro da família. Os entraves residem no risco de transmissão de microrganismos a pacientes com sistema imunológico imaturo ou debilitado, juntamente com as políticas internas de muitos centros, que impedem a entrada de crianças pequenas como visitantes. Resumen Objetivo: Analizar la importancia de las visitas de hermanas y hermanos de los recién nacidos hospitalizados en las Unidades de Neonatología desde las experiencias que se relatan en la literatura. Métodos: Para proporcionar una reflexión de las experiencias en el mundo, se realiza una revisión de artículos que contienen la temática de hermanos, seleccionados por amplitud del estudio ya sea experiencia cuantitativa, cualitativa o mixta. Conclusión: La importancia de la implementación de las visitas de los hermanos en los diversos centros hospitalarios radica en su detección como un factor fundamental que permite disminuir el estrés parental y familiar, mejorando los lazos entre hermanos y la comunicación en el interior de la familia. Los impedimentos radican en el riesgo de transmisión de microorganismos a pacientes que poseen un sistema inmune inmaduro o debilitado, junto con las políticas internas de muchos centros, que impiden el ingreso de niños pequeños como visitas.
... This result is consistent with a recent study that analyzed the application of FCC in Italian NICUs from the perspective of health care professionals (44). Furthermore, our analysis confirmed the chronic issue of limited access, which, as shown in previous studies (45,46), interests several Italian NICUs. Our findings may stimulate reflection and further research on how the FCC standards are implemented in Italian NICUs. ...
Though many data on the experience of care of patients and caregivers are collected, they are rarely used to improve the quality of health care delivery. One of the main causes is the widespread struggle in interpreting and enhancing these data, requiring the introduction of new techniques to extract intelligible, meaningful, and actionable information. This research explores the potentiality of the latent class analysis (LCA) statistical model in studying experience data. A cross-sectional survey was administered to 482 parents of infants hospitalized in several Italian neonatal intensive care units. Through a 3-step LCA, four subgroups of parents with specific experience profiles, sociodemographic characteristics, and levels of satisfaction were identified. These were composed of parents who reported (1) a positive experience (36%), (2) problematic communication with unit staff (30%), (3) limited access to the unit and poor participation in their baby's care (26%), and (4) a negative experience (8%). Through its explorative segmentation, LCA can provide valuable information to design quality improvement interventions tailored to the specific needs and concerns of each subgroup.
... NICUs were developed in the 1950 s and 1960 s by pediatricians to provide better temperature support, isolation from infection risk, specialized feeding, and greater access to specialized equipment and resources. In this unit, infants are cared for in incubators or "open warmers", public access is limited, and staff and visitors are required to take precautions to reduce transmission of infection [1,2]. The availability of NICUs has improved the outcomes of high-risk infants born either preterm or with serious medical or surgical conditions [3]. ...
Growing evidence suggests that early-life events can predispose the newborn to a variety of health problems in postnatal life, which can lead to the need for specialized care in the neonatal intensive care unit (NICU). These events may be caused by factors intrinsically related to the mother (i.e., lifestyle, socioeconomic conditions), and this interplay between maternal exposure factors and negative outcomes in the neonate can be efficiently monitored through effect biomarkers, such as DNA damage. Thus, the present study aimed to evaluate the DNA damage and the maternal and neonatal factors associated with the genotoxic outcome using newborns admitted to the NICUs of three hospitals located in the extreme south of Brazil. A total of 81 newborns were evaluated. DNA damage was assessed using the comet assay, and according to the result obtained for the evaluated parameters (tail length, % of tail DNA and tail moment). The investigation of associated factors was performed using the bivariate and multivariate Poisson regression analysis. As a result, we observed that the tail moment was the most sensitive parameter to detect differences between variables and genetic outcomes in newborns from NICU. Birthweight and the presence of respiratory diseases were associated with greater risks of DNA damage. Furthermore, the variables family income, sex, head circumference, preterm, birthweight and the presence of respiratory and/or infectious diseases showed a significant statistical difference regarding the groups with and without DNA damage (based on the median of the parameter). While the results of this study will serve as the basis for investigating genetic damage, we encourage that similar studies should be conducted elsewhere in order to confirm these and other outcomes as associated factors with DNA damage in newborns.
... One potential reason for this association is the lack of opportunities for 'important others' to be present and involved. Studies have shown that few NICUs allow 'important others' to participate in the care process without restrictions (e.g., accompanied by parents or staff agreement; Flacking et al., 2019;Greisen et al., 2009). Further, the awareness of how it is for parents to become parents in a NICU may not be well understood by 'important others' and therefore emotional support is difficult to provide. ...
Aims and objectives:
This study aimed to explore staff attitudes and experiences of parents' friends and families' social presence and involvement in neonatal intensive care units (NICUs).
Background:
In NICUs, parents need emotional and practical support during infant hospitalisation. Friends and families of parents may constitute the most significant providers in this support, but few studies are available on when and how these 'important others' can be present and involved.
Design:
This qualitative descriptive study was based in the philosophical tenets of naturalistic inquiry.
Methods:
Seven focus groups were conducted where 67 staff from Denmark, Finland, Iceland and Sweden participated. Data were analysed using thematic analysis. The study was reported following the COREQ guidelines and checklist.
Results:
The overarching theme showed that 'important others' were an unaddressed group of potential supporters in the periphery. The five identified themes described how staff recognised 'important others' as the parents' territory, but that 'important others'' presence and involvement needed to be negotiated with staff. Although the staff regarded 'important others' as necessary for parents' emotional, practical and social support, they felt less obligated to support them as part of their work remit. The staff also felt that inclusion of 'important others' was an essential step forward in achieving family centred care.
Conclusions:
The findings indicate that 'important others'' involvement was primarily guided by proactive parents and unit care culture rather than by staff's formal written guidelines or guidance. Single-family rooms seemed to enhance the presence and involvement of 'important others'.
Relevance to clinical practice:
There is a need for more staff resources to enable and support the participation of 'important others'. Parents need to be included during the development of policies to provide their experiences. Finally, more research is needed on what parents wish from their 'important others'.
... In contrast, within the family, childcare provision by grandparents and multigenerational cohabitation have been reidentified as having a positive impact on mothers' employment, although public childcare services and parents are still the two main providers of childcare (Jappens and Van Bavel, 2012;Thomese and Liefbroer, 2013;Hank and Buber, 2008;Greisen et al., 2009;Brandt et al., 2009;Igel and Szydlik, 2011;Kanji, 2018). From a macro perspective, childcare configuration differs according to the welfare state regime (Campbell, 2009;Aboim, 2010) and grandparents' role in relation to their younger family members also differs according to the welfare state regime. ...
Purpose
This article aims to explore how Japanese women with younger children changed their commitment to the labour market between 2000 and 2019 by comparing mothers in three-generation and nuclear family households.
Design/methodology/approach
Japan currently has the highest ageing rate in the world at nearly 30%. Since the 1990s, employment flexibilization and women's labour market participation have proceeded in parallel, and the conservative family values of the patriarchy and gender division of labour that have provided intergenerational aid for care within households have been shrinking, by conducting a descriptive analysis of the Labour Force Survey (LFS).
Findings
This study identified that a conspicuous increase in part-time employment among mothers in both household types and a decrease by half in the working mother's population in three-generation households. These results suggest that the function of inter-generational assistance by multi-generation cohabitation, which was once thought to be effective in helping working mothers with younger children, is declining.
Originality/value
A study examining the transformation of mothers' employment behaviour differences between three-generation households and nuclear family households is rare. This paper makes a new contribution to the research regarding the grandparents' caregiving, household types and mothers' employment.
... (9) Besides, the participation of the parents is influenced not only by the presence of other children at home, but also by personal limitations such as working time, distance from the hospital, and travel expenses. (10) In this way, the parents, especially the mother, are the axis around which the various strategies aimed at promoting the achievement of better care, development, and a better quality of life in the future of newborns and their families are developed. This is encompassed by family-centered care (FCC), an approach to medical care that is based on the association of patients, families, and health professionals whose objective is to empower the patient's family by promoting direct participation in their care. ...
... 13,14 Continuous parental support and access and high parental involvement is recommended at national 14 and European 15 levels, although policies vary widely between European countries, as well as between medical establishments within the same country. 16 Overall, the presence of fathers in the NICU has been acknowledged as a source of support for the well-being of mothers and, thereby, of infants. 17,18 Despite this, the vast majority of the early interventions involving parents in NICUs have been performed by mothers, 19 also in individualized care contexts. ...
Aim
This review identifies interventions involving the fathers of preterm infants that have been tested in neonatal intensive care units (NICU). It examines their effects on the fathers and infants and highlights any differences between fathers and mothers who took part in the same interventions.
Methods
A systematic search was performed in English from 1995 to first of September 2020, using the CINAHL, Cochrane Central Register of Controlled Trials, Embase, PubMed and PsycINFO databases. We examined 14 peer-review studies that investigated NICU interventions involving 478 fathers, whose 511 infants were born before 37 weeks of gestation. These included empirical studies with clinical outcomes.
Results
Studies on fathers’ interventions in NICUs were limited and mainly restricted to basic skin-to-skin contact or tactile interventions. The interventions had similar general positive effects on mothers and fathers when it came to infant physiological and behavioural reactions. There was also evidence of a positive effect on the fathers, including their mental health.
Conclusion
Including fathers as active partners in the care of their preterm newborn infants produced good outcomes for both of them. Further research is needed to develop new, multimodal and interactive interventions that provide fathers with positive contact with their preterm infants.
... It also underlined the general difficulty of observing infants while giving care, and the difficulties of observing certain components or systems, especially if they varied throughout caregiving. Although NIDCAP has changed the NICU practices and environment and increased parental involvement (Als et al., 2003;Greisen et al., 2009;Pierrat et al., 2016), few studies have provided factual data on the dissemination of observation skills to uncertified caregivers after programme implementation in a neonatal unit or department. According to the Edmonton NIDCAP trial, approximately 20% of the NICU staff members had been educated to provide NIDCAPbased care, and the results suggested that this education had effectively imparted to nurses the ability to understand and respond to preterm infant behaviour (Peters et al., 2009). ...
Aim:
To assess nurses' ability to observe newborn behaviour after in situ training provided by caregivers with advanced practice certification in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).
Design:
Prospective observational study.
Methods:
Twelve nurses viewed 20-min films showing the behaviour of 10 premature newborns before, during and after the usual caregiving. The behaviour was rated on an observation sheet with 88 items distributed into six systems. The responses were compared to the reference ratings established by two professionals certified for this programme.
Results:
Despite less accurate observations during care and for some components, the nurses generally showed a satisfactory ability to observe newborn behaviour after training by NIDCAP expert professionals. The dissemination of observation skills among caregivers may result in an improved quality of patient care and better communication among professionals in a department of neonatology.
... Nurse-driven, family-centred discharge preparation programmes have been developed and implemented well in countries such as the United States and Canada (American Academy of Pediatrics Committee on & Newborn, 2008;Jefferies, 2014;Purdy, Craig, & Zeanah, 2015). In countries such as China, Iran, and some European countries, the restrictive visitation policies in NICU reduce parental engagement in caring for their infants and the opportunities for parents to acquire caring knowledge and skills at bedside (Bastani et al., 2015;He et al., 2018;Greisen et al., 2009). Currently, although nurses routinely perform discharge teaching for parents on the day of discharge in China, there is no standardized discharge preparation programme for parents (Jingxia et al., 2019). ...
Aim
To describe the facilitating/inhibiting factors of preparation for preterm infant discharge and recommendations for increasing discharge readiness from parents’ and healthcare providers’ perspectives based on Meleis's Transitions Theory.
Design
A qualitative cross‐sectional descriptive design.
Methods
We selected a purposive sample of 17 parents (9 fathers and 8 mothers) and 13 healthcare providers (10 nurses and 3 clinicians) from the neonatal intensive care unit of a tertiary hospital in Eastern China. Data were collected between May ‐July 2018. Data from audio‐recorded semi‐structured individual interviews were coded with content analysis both inductively and deductively.
Results
The analyses yielded four themes: personal conditions, community conditions, nursing therapeutics, and patterns of response. Parents and healthcare providers had unique opinions about the themes.
Conclusion
Meleis's Transitions Theory seems to be an applicable and practicable framework for understanding the discharge preparation of parents with preterm infants and may be used to help healthcare providers to develop appropriate interventions on discharge preparation practice.
Impact
To address the lack of discharge readiness of preterm infants in China and countries with a similar clinical context, healthcare providers should help parents play a more active role to promote their engagement in discharge preparation. In a wider global community, healthcare providers should consider parents’ personal conditions and their practical needs in performing discharge preparation.
... However, parents' participation in infant pain management was not popular with health-care professionals in NICU. Greisen et al. (11) investigated policies regarding families visiting NICUs in eight European countries and suggested that unrestricted parental presence is not yet a uniformly accepted standard among European NICUs, and that parental presence is often restricted during medical rounds and procedures. Regarding pain management, a national survey showed that only 11% of Japanese NICUs involved parents in pain management (12), and French NICU mothers reported that they received some information on infants' pain, but only 23% perceived the information they received as sufficient (9). ...
... 19 In most neonatal units in France, parental presence is allowed 24/7 and parents participate actively in caring for their infant. 20,21 Unlimited parental access over 24 hours increased in our country from 67% in 2004 to 89% in 2011 as reported in the NICU participating in the EPIPAGE 2 national cohort study. 22 Nevertheless, there are still physical, emotional and environmental factors that influence parental engagement in neonatal units. ...
Background:
Parents of term and preterm infants hospitalised at birth experience a stressful situation. They are considered as primary caregivers in neonatal units and are encouraged to participate in their child's care.
Objectives:
The aim of our study was to analyse the feelings of parents participating for the first time in caregiving for their baby admitted at birth in a neonatal unit in France and to compare the feelings reported by parents of term and preterm infants.
Methods:
An online survey was created in 2014 for parents who had a baby hospitalised at birth. We analysed parents' responses to this open-ended question: "How did you feel when you participated in caregiving for your baby for the first time?" using a qualitative discourse analysis by two analysts. Themes were identified and coded.
Results:
Between February 2014 and March 2018, 1603 parents of preterm infants and 239 parents of term infants responded to this open-ended question. Twenty-five per cent of parents expressed positive feelings exclusively (confidence, ease, joy, pride, feeling supported by healthcare professionals, by their family and feeling of being a parent), 41% expressed negative feelings exclusively (stress, fear, feeling of being judged, frustration, anger, uselessness and clumsiness) and 34% expressed mixed feelings (both positive and negative). Parents of term infants expressed less frequent feelings of stress and fear than parents of preterm infants: with a relative risk (RR) of 0.69, 95% confidence interval (CI) 0.56, 0.87. Parents of term babies more frequently expressed feelings of frustration: RR 2.40 (95% CI 1.33, 4.32).
Conclusions:
Infant- and Family-Centred Developmental Care supportive programmes are recommended within neonatal units in order to improve the experience of parents participating in caregiving for their baby hospitalised at birth.
... However, parents' participation in infant pain management was not popular with health-care professionals in NICU. Greisen et al. (11) investigated policies regarding families visiting NICUs in eight European countries and suggested that unrestricted parental presence is not yet a uniformly accepted standard among European NICUs, and that parental presence is often restricted during medical rounds and procedures. Regarding pain management, a national survey showed that only 11% of Japanese NICUs involved parents in pain management (12), and French NICU mothers reported that they received some information on infants' pain, but only 23% perceived the information they received as sufficient (9). ...
... Um estudo envolvendo nove países europeus e 175 unidades de terapia intensiva neonatal com pelo menos 50 admissões mensais de recém-nascidos de muito baixo peso apontou que, apesar de melhorias nas políticas de acesso de familiares, ainda há barreiras, principalmente nos países participantes situados no sul da Europa (França, Espanha e Itália). Quanto à visitação por irmãos, 75% das instituições permitem a prática, contudo, majoritariamente sob acompanhamento dos pais, sendo outras opções apenas aceite ou perante assentimento dos profissionais (26) . Na América do Sul, 15 das 52 unidades de terapia intensiva neonatal, analisadas mediante questionário aplicado às enfermeiras, não permitem visitação dos irmãos. ...
Objective:
To analyze maternal care for siblings of preterm babies hospitalized in the neonatal intensive care unit.
Method:
Qualitative research using symbolic interactionism as a theoretical reference and narrative research as a methodological reference. Ten mothers were surveyed through semi-structured interviews.
Results:
Three thematic units emerged from the analysis of data: "social support in the sharing of child care"; "promotion of adaptation to the arrival of a sibling" and "maternal feelings and coping".
Final considerations:
Care for the premature child's sibling is developed under mothers' physical distance from him/her, justified by the need to remain close to the premature child due to risks and fragility related to the condition.
... Parents are allowed to visit the NICU 24 h a day in the United States; and research reported that parents visited their infant 78% of the time during hospitalization (Reynolds et al., 2013). A survey of 175 NICUs in eight European countries reported that parents were allowed visitation at any time in all NICUs in Denmark, Sweden and the United Kingdom, in 90% of those in the Belgium and Netherlands and 71% of the French NICUs (Greisen et al., 2009). Raiskila et al. (2017) found that parents' presence lasted from a few hours to almost 24 h per day in 11 NICUs in six European countries, including Finland, Norway, Sweden, Estonia, Spain, and Italy. ...
Purpose:
To explore Chinese parents' experiences and expectations of having preterm infants in a Chinese neonatal intensive care unit.
Design and methods:
A qualitative descriptive design with semi-structured interviews was used to describe the experiences and expectations of parents of preterm infants in a neonatal intensive care unit in the central region of China. Purposive sampling was adopted to recruit parents (n = 15) of preterm infants and data were collected by face-to-face interviews from January to May 2018. Themes were identified by thematic analysis. This study followed the consolidated criteria for reporting qualitative research (COREQ).
Results:
Five themes emerged from the analysis: (1) mixed emotional experiences; (2) separation from the infants; (3) perceived incompetence in taking care of preterm infants; (4) obtained support through various sources; (5) desired more from healthcare professionals.
Conclusions:
Parents experienced additional emotional burdens due to separation from their infants as well as a lack of an effective approach to their associated needs. While NICU staff adopted several strategies to help parents cope with their infant hospitalization, these parents still expected to receive more support from healthcare providers to meet their needs.
Practice implications:
Healthcare providers should be more aware of parents' various needs in neonatal intensive care units and of their important role as constant caregivers. Hospital-based neonatal care should be specifically designed to supply positive support and necessary strategies for parents to strengthen their confidence in parenting infants.
... Despite the increasing emphasis upon family-centred and developmental models of care, research shows wide differences in NICUs' and SCNs' provision of facilities to enable parental presence and involvement Malusky 2005). Policies regarding visitation and visitation times, overnight stays and skin-to-skin care vary widely across units and countries (Greisen et al. 2009;Latva et al. 2007;Reynolds et al. 2013). ...
The Parenting Premmies Support Program: developing and piloting a mobile health intervention for mothers of preterm infants. The study presented in this thesis aimed to investigate the use of contemporary mobile health technology as a vehicle to support and promote the health and wellbeing of mothers of preterm infants during the transitional time following their infant’s discharge from hospital. An exploratory, mixed methods approach with a three phase design was used to understand maternal experience, challenges and issues in this context, develop an mHealth protocol that formed the program, and finally, pilot the program.
... Grandparents are also trying to cope with this new crisis and may relive their own birthing experiences, which could result in associated anxieties and prevent them from being available to provide support for the parents (Frisman, Eriksson, Pernehed, & Morelius, 2012). Extended family members may be more helpful if discord exists between grandparents and the nuclear family (Greisen et al., 2009). Friends of the family can be an asset if they are effective listeners. ...
... A NICAP care model needs to be tailored to the social and culture cultural context within which the NICU is embedded. Despite the importance of interaction between mother and newborn and the attention to the developmental care of the neonate, there is still regional resistance (Greisen et al., 2009). Proper and successful implementation of the NIDCAP program depends on the practice culture, staff education, and engagement of parents. ...
... Based on these concepts, the NICU environment and care have continually been improved to reduce parent-infant separation and increase integration of the parents. For example, parents are gradually becoming more and more involved in care activities for their infant (Nyqvist & Engvall, 2009;O'Brien et al., 2013); extended skin-to-skin contact is part of care in many units (Gonya & Nelin, 2013;Nyqvist et al., 2010); unlimited parental presence, with few restrictions on the presence of siblings, other family members and friends, is common in many European countries (Greisen et al., 2009); and having a bed for parents next to the infant has also been introduced in more units (Authors Blinded, 2009). Moreover, hospital-based neonatal home care programs (HNHC) have been established in many units in western countries in the last decades to integrate FCC principles in the transition from NICU to the home (Dellenmark-Blom & Wigert, 2014;Mai & Wagner, 2005;Toral-Lopez et al., 2016). ...
Aims and objectives
To present parents’ lived experience of having a preterm infant cared for at the neonatal unit until discharge from hospital‐based neonatal home care (HNHC).
Background
Becoming a parent to a preterm infant has been reported as an experience that may influence the parent's lifeworld also after discharge. Interventions have been implemented at the NICUs, e.g. introduction of family‐centred care aiming to reduce parent‐infant separation, increased integration of the parents, in order to support them in their altered parental role.
Design
A descriptive phenomenological interview study.
Methods
Six parent couples at a NICU in Sweden were included and interviewed individually after discharge from HNHC. The interviews were analyzed from the perspective of caring sciences using a descriptive phenomenological method. The study followed the Consolidated criteria for reporting qualitative research (COREQ) checklist.
Result
The journey from birth to discharge from hospital‐based neonatal home care affected the parents’ lifeworld. The parents’ experiences differed. Mothers experienced more physiological reactions that triggered feelings of existential loneliness and guilt and difficulties in combining the role of mother with partner. The fathers faced conflicts managing their partners’ demands, family challenges, and employers who claimed their time and energy, which negatively affected their transition into fatherhood.
Both mothers and fathers experienced ambivalent feelings in the relationships with the professional staff, which was more strongly expressed by the mothers.
Conclusion
It is important for health care providers to help parents clarify their individual needs and values in caring for a preterm infant to help them achieve parental and family wellbeing.
Relevance to clinical practice
These findings can guide health care providers to help parents improve care for their preterm infants in the NICU. Integrating a person‐centered approach such as supportive person‐centered dialogues focused on parents’ individual needs might be one way to support parents.
This article is protected by copyright. All rights reserved.
... Parental presence in a NICU is greater when there is implementation of infant-and family-centered developmental care, and when the NICU design supports increased parental presence by providing single family rooms (Lester et al., 2016). Studies that compared parental access and involvement of parents in the care of infants in Europe indicated increased parental presence in the Nordic countries (Greisen et al., 2009;Pallas-Alonso et al., 2012). Significant discrepancies remain among the NICUs in Europe, and there is evidence that providing parents the opportunity to stay overnight in a NICU prolongs the time they can spend with their newborns (Raiskila et al., 2017). ...
... Parental presence in a NICU is greater when there is implementation of infant-and family-centered developmental care, and when the NICU design supports increased parental presence by providing single family rooms (Lester et al., 2016). Studies that compared parental access and involvement of parents in the care of infants in Europe indicated increased parental presence in the Nordic countries (Greisen et al., 2009;Pallas-Alonso et al., 2012). Significant discrepancies remain among the NICUs in Europe, and there is evidence that providing parents the opportunity to stay overnight in a NICU prolongs the time they can spend with their newborns (Raiskila et al., 2017). ...
Preterm infants (PTI) typically experience many painful and stressful procedures or events during their first weeks of life in a neonatal intensive care unit, and these can profoundly impact subsequent brain development and function. Several protective interventions during this sensitive period stimulate the oxytocin system, reduce pain and stress, and improve brain development. This review provides an overview of the environmental risk factors experienced by PTI during hospitalization, with a focus on the effects of pain, and early maternal separation. We also describe the long-term adverse effects of the simultaneous experiences of pain and maternal separation, and the potential beneficial effects of maternal vocalizations, parental contact, and several related processes, which appear to be mediated by the oxytocin system.
... A NICAP care model needs to be tailored to the social and culture cultural context within which the NICU is embedded. Despite the importance of interaction between mother and newborn and the attention to the developmental care of the neonate, there is still regional resistance (Greisen et al., 2009). Proper and successful implementation of the NIDCAP program depends on the practice culture, staff education, and engagement of parents. ...
... 35 Evidence suggests that European NICUs also have limited visiting hours such as in Spain, Italy, and France, and most NICUs have restrictions to parental presence during rounds or procedures. 36 Implementing FCC can be challenging for clinicians. A study in 11 NICUs in Europe identified that the lowest rated principles of FCC were emotional support, parental involvement in decision-making, and fathers' involvement in care. ...
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.
... 4 Research has shown wide variation in European neonatal intensive care units' (NICUs) capabilities, both to provide facilities for parental presence and in policies to enable parental participation. 5,6 Many challenges, such as professionalcentred staff attitudes, lack of training in communication skills, and open-bay unit architectures, set barriers to the implementation of FCC. In a traditional professional-centred NICU care culture, FCC may raise concerns regarding issues of power, control and the division of responsibilities. ...
Objectives:
To describe the policies about parent visiting and involvement in care during admission to French PICUs.
Design:
A structured questionnaire was emailed to the chief of each of 35 French PICUs. Data about visiting policies, involvement in care, evolution of policies, and general characteristics were collected from April 2021 to May 2021. A descriptive analysis was conducted.
Setting:
Thirty-five PICUs in France.
Patients:
None.
Interventions:
None.
Measurements and main results:
Twenty-nine of 35 (83%) PICUs replied. Twenty-four-hour access for parents was reported for all PICUs responding. Other allowed visitors were grandparents (21/29, 72%) and siblings (19/29, 66%) with professional support. Simultaneous visits were restricted to two visitors in 83% (24/29) of PICUs. Family presence was always permitted during medical rounds for 20 of 29 (69%) PICUs. Most of the units rarely or never allowed parental presence during the most invasive procedures, such as central venous catheter placement (18/29, 62%) and intubation (22/29, 76%).
Conclusions:
Unrestricted access to the PICU, for both parents, was available in all responding French units. There were, however, restrictions on the number of visitors and the presence of other family members at the bedside. Moreover, permission for parental presence during care procedures was heterogenous, and mainly restricted. National guidelines and educational programs are needed to support family wishes and promote acceptance by healthcare providers in French PICUs.
Importance
Surveys based on hypothetical situations suggest that health-care providers agree that disclosure of errors and adverse events to patients and families is a professional obligation but do not always disclose them. Disclosure rates and reasons for the choice have not previously been studied.
Objective
To measure the proportion of errors disclosed by neonatal intensive care unit (NICU) professionals to parents and identify motives for and barriers to disclosure.
Design
Prospective, observational study nested in a randomised controlled trial (Study on Preventing Adverse Events in Neonates (SEPREVEN); ClinicalTrials.gov). Event disclosure was not intended to be related to the intervention tested.
Setting
10 NICUs in France with a 20-month follow-up, starting November 2015.
Participants
n=1019 patients with NICU stay ≥2 days with ≥1 error.
Exposure
Characteristics of errors (type, severity, timing of discovery), patients and professionals, self-reported motives for disclosure and non-disclosure.
Main outcome and measures
Rate of error disclosure reported anonymously and voluntarily by physicians and nurses; perceived parental reaction to disclosure.
Results
Among 1822 errors concerning 1019 patients (mean gestational age: 30.8±4.5 weeks), 752 (41.3%) were disclosed. Independent risk factors for non-disclosure were nighttime discovery of error (OR 2.40; 95% CI 1.75 to 3.30), milder consequence (for moderate consequence: OR 1.85; 95% CI 0.89 to 3.86; no consequence: OR 6.49; 95% CI 2.99 to 14.11), a shorter interval between admission and error, error type and fewer beds. The most frequent reported reasons for non-disclosure were parental absence at its discovery and a perceived lack of serious consequence.
Conclusion and relevance
In the particular context of the SEPREVEN randomised controlled trial of NICUs, staff did not disclose the majority of errors to parents, especially in the absence of moderate consequence for the infant.
Trial registration number
NCT02598609 .
Drawing upon diverse methodological and contextual inquiry, this chapter provides insights into parents’ experiences in neonatal intensive care settings following preterm birth. Parents’ experiences after preterm birth are generally viewed as stress provoking. These stresses arise from several sources including infant health, physical and cultural environment of the neonatal unit, challenges to pre-existing identity and assumptions, and how they are supported and prepared for parenthood transitions. How parents react to and cope with these stresses is moderated by the individual personality, gender-based assumptions about appropriate responses, and how parents are integrated into neonatal unit and infant care activities. Improved communication with health professionals, feeling listened to, having their needs for emotional support understood, getting involved in infant care, and developing deeper understandings of their baby’s expected behaviour and developmental trajectory empower parents, reduce their anxieties, and help them to establish robust responses to the challenges mothers and fathers face following preterm parenthood.
Background
A smooth transition from the neonatal intensive care unit (NICU) to home is critical for establishing parents' competence as primary caregivers and ensuring infant health. In the clinical context with a restrictive visiting policy, family-centred care is challenging to implement, prohibiting a smooth transition of care for the families. According to Meleis’ Transition Theory, parents might experience emotional change initiated by critical events during this transition.
Objectives
The aim of this study was to understand parents' emotional experience of their preterm infant's birth to discharge home from the NICU to facilitate the care transition better.
Methods
This qualitative descriptive study using semistructured interviews was conducted between June and August 2020. Purposive sampling was used to recruit 17 parents (6 fathers and 11 mothers) from the NICU of a tertiary hospital in eastern China. Data were analysed using content analysis.
Results
The following three situational themes characterised by three-phase emotions related to 16 critical events were obtained from the data and were used to describe parents’ experiences during the transition: Theme 1, Life falling apart; Theme 2, Feeling anxious and struggling with uncertainty; and Theme 3, Feeling both hopeful and inadequate at discharge.
Conclusions
Parents of preterm infants have distinctive emotional experiences in each phase during their infants' transition from the NICU to home. Awareness of parents’ critical events and emotional experiences in each phase could help NICU staff anticipate and provide timely and targeted support for parents. The next step is to develop a family-centred intervention for healthcare providers to better prepare parents for the transition from the NICU to home.
Developmental care is defined by a personalized approach to the premature child. Observation of sensory-motor behavior is a key part of this approach and requires specific training and the use of observation tools. This study analyzes the use of an illustrated guide during the observation and evaluation of the sensory-motor behavior of the premature baby; this didactic contribution constitutes a real added value for the professionals, allowing the elaboration of a care project.
Aim:
This study sought to describe how skin-to-skin contact between extremely or very preterm infants and their parents is practiced in Swedish neonatal units.
Methods:
Data from the Swedish Neonatal Quality Register from 2020-21 was extracted to analyse initiation time and daily duration of skin-to-skin contact in different gestational ages and regions.
Results:
Of the 1475 infants in the cohort, mean (range) gestational age was 28 weeks (22-31), and mean (range) birth weight was 1205 grams (360-2810). For extremely preterm infants (<28 weeks), median (interquartile range) skin-to-skin contact initiation time was at 88 postnatal hours (48-156) and 5% had skin-to-skin contact on the first day. For very preterm infants (<32 weeks) the corresponding numbers were 14 hours (4-36) and 34%. Median (interquartile range) daily skin-to-skin contact duration for the entire cohort during the first day, first three and seven days and the remaining hospital stay was 0 (0-0), 0.7 (0-2.7), 1.6 (0.4-3.6) and 4.4 (3.0-6.1) hours, respectively.
Conclusion:
A minority of extremely and very preterm infants were exposed to skin-to-skin contact on the first postnatal day. Daily duration during the first week of life amounted to less than two hours. Initiation time and daily duration varied among gestational ages.
Background:
Family process disruption is one of the main consequences of the hospitalization of a critically ill child in a Paediatric Intensive Care Unit (PICU). Children's visits to PICU may help improve family coping. However, this is not standard practice and nurses' experiences in facilitating children's visits to units where it is encouraged is unknown.
Aim:
To explore nurses' experience related to promoting the visits of siblings to PICU.
Methods:
An interpretative phenomenological study was carried out through in-depth interviews in two PICUs belonging to third level public hospitals in Madrid. Twelve nurses with more than two years of experience in PICU were interviewed. They were all were working in PICU during the study. Furthermore, a PICU psychologist with an experience of four years was interviewed and this was considered shadowed data. Data analysis followed a thematic discourse analysis.
Results:
Nurses' experience of facilitating children's visits to PICU can be condensed into four themes: emerging demand for visits, progressive preparation, decision-making through common consensus and creating intimate spaces.
Conclusions:
The experience of nurses in facilitating visits is mainly in response to the demand of families going through prolonged hospitalisation or end-of-life situations. The role of the nurse is one of accompaniment, recognising the major role of parents in the preparation of children and in developing the visit. Nurses feel insecure and lack resources for emotional support and demand action protocols to guide intervention and decision making.
Background:
Healthcare providers working in neonatal intensive care units (NICUs) are considered at high risk for psychological work-related stress.
Purpose:
To evaluate both perceived and biological measures of work-related stress in neonatal healthcare professionals and to compare professionals working in the NICU with their colleagues working in less critical environments (ie, neonatal wards [NWs]).
Methods:
The salivary cortisol level at the beginning (CORT-B) and at the end (CORT-E) of a daily work shift was collected once a week for 6 weeks and a psychological questionnaire was submitted to NW and NICU workers of a tertiary university center.
Results:
No differences emerged in the overall cortisol secretion between professionals (NW 45 vs NICU 28), but the decrease in the mean cortisol values between CORT-B and CORT-E was less pronounced in NICU professionals (P < .001) who had greater psychological stress (P < .001). Lack of correlation between perceived and biological indexes was observed.
Implications for practice:
NICU professionals reported greater levels of self-perceived psychological stress, especially in terms of professional self-doubt and the complexity of interactions with infants and their parents.The disconnection between psychological and biological indexes raises the issue that work-related stress might be covert to the professionals themselves. Dedicated resources should be developed to address quality of life and the work environment of NICU professionals.
Implications for research:
The absence of a correlation between perceived and biological indexes highlights the need to incorporate multidimensional physiological and biological measurements in evaluating burnout levels in neonatal healthcare providers.
Purpose
This work aimed to investigate obstacles and facilitators for carrying out Kangaroo Mother Care (KMC) across Italian NICUs.
Design and methods
A survey that investigated Unit's characteristics, policies toward parents and KMC practice and policies was carried out. Data from 86 NICUs (80.4%) was collected. Descriptive statistics and Multiple Regression Models were computed.
Results
Eighty-one NICUs provided KMC. These NICUs had a less restricted parental access policies (chi² = 7.373, p = .007). More than the 70% of the units did not have adequate facilities for parents. KMC daily length was positively predicted (R² = 0.18, F = 7.91, p = .001) by repeated sessions and documentation of KMC.
Conclusion
The implementation of KMC is characterized by different barriers and facilitators that determine the parent's possibility to provide KMC. Structural factors (e.g., adequate space and facilities) can support families in providing KMC. A unique result of this survey is that KMC documentation on medical records appears critical for improving its practice.
Practice implications
Although most of the Italian units provide KMC as a routine practice, improving its practical support would be beneficial to its implementation. A more formalized approach to KMC may strengthen staff habits to consider KMC like a standard care treatment.
Resumen
Introducción y antecedentes
La disrupción de los procesos familiares es una de las principales consecuencias de la hospitalización de un niño críticamente enfermo en una Unidad de Cuidados Intensivos Pediátricos (UCIP). La visita de los niños a la UCIP puede contribuir a mejorar el afrontamiento familiar. Sin embargo, no es una práctica habitual y se desconoce cuáles son las experiencias de las enfermeras en torno a facilitar la visita infantil a unidades donde se promueve.
Objetivo
Explorar la experiencia de las enfermeras en relación con la facilitación de la visita infantil a la UCIP.
Método
Estudio fenomenológico interpretativo mediante entrevistas en profundidad. El estudio se desarrolló en las UCIP de dos centros públicos madrileños de nivel IIIC. Participaron 12 enfermeras con experiencia mayor de dos años en UCIP que, en el momento de la entrevista, prestaban servicios en dichas unidades. Además, se entrevistó a una psicóloga con experiencia de cuatro años en UCIP cuya información se consideró en el contexto de los datos en la sombra. La información se analizó mediante un análisis temático del discurso.
Resultados
La experiencia de las enfermeras en relación a la facilitación de la visita infantil a la UCIP se puede condensar en cuatro temas: el emerger de la demanda, la preparación progresiva, la toma de decisiones desde el consenso y la creación de espacios de intimidad.
Conclusiones
Las experiencias de facilitación de la visita responden, principalmente, a la demanda de las familias que viven hospitalizaciones prologadas o al final de la vida. El rol de la enfermera es de acompañamiento reconociendo la labor prioritaria de los padres en la preparación de los niños y el desarrollo de la visita. Las enfermeras se sienten inseguras y faltas de recursos para el apoyo emocional y reclaman protocolos de actuación que orienten la intervención y toma de decisiones.
Background:
Newborns in neonatology are exposed to invasive and painful procedures. The absence of parents during procedures revealed significantly high pain scores.
Objective:
The aim of this study was to assess practices regarding the role of parents during painful and invasive procedures.
Methods:
This was a prospective, observational, multicenter study in France in which 471 caregivers participated. Professional practices regarding the role of parents during painful procedures on their child were assessed. Univariate and multivariate analyses were performed to identify factors associated with parental presence during painful procedures.
Results:
Parental presence was most often allowed during capillary blood sampling, nasogastric tube insertions, and vein punctures, whereas it was mostly restricted during central line insertions, extubations, lumbar punctures, and intubations. However, we found discrepancies depending on the type of facility and caregiver seniority.
Conclusion:
An important variability in practices concerning the role of parents during painful and invasive procedures on their child was reported.
Statement of standard The hospital sensory environment is adjusted to the infants’ sensory expectancies and perceptual competences.Rationale The hospital environment may be challenging for the infant and their parents. Developmental neurosciences and psychology have enlightened the complex relationships between the environment and brain development. (1) Sensory systems develop progressively and continuously from fetal to neonatal life, with a timeline specific to each sensory modality (2,3); even extremely preterm infants are sufficiently mature to react to their environment. (4) Early brain development is genetically driven, but as early as the third trimester of pregnancy it becomes also sensory driven. Thus the period of hospitalisation is critical, since the sensory experiences can impact neurodevelopment, through many factors including synaptogenesis, synapses elimination, and epigenetic factors. (1,5–8) The harmful role of stressful/painful (over)stimulations and their long-term potential impact have been described. (9–11) As maternal stimuli are particularly salient for newborn infants, the hospital environment poses also a risk of sensory deprivation of biologically meaningful inputs for the infant. (12) Early and prolonged separation from their family can alter the bonding process and later mutual interactions. (13) Both basic and medical research support the provision of a sensory nurturing environment. It is essential to protect infants from deleterious environmental stimuli and to support their access to positive sensory stimulations from their parents and other caregivers. Sensory interventions in the NICU, adjusted to the infants’ needs and responses, attuned to their current developmental stage, are at best implemented through individualised programmes. Skin-to-skin contact is the best strategy to restore some of the sensory discontinuity associated with preterm birth. Benefits Enhanced, natural and direct exposure of the hospitalised infant to hedonically positive and/or biologically meaningful stimuli is provided during social interactions mainly through intimate contact between the mother (partner) and the infant, and minimising exposure to environmental stressors (see TEG NICU design). Theseenhanced sensory experiences are mainly delivered through skin-to-skin care, early vocal contact (direct talking and singing), exposure to maternal/paternal scents, access to breast milk taste and smell, eye contact, touch, and massage. Benefits may also come from other sensory interventions which are individually attuned to the behavioral state of the newborn infant: hedonically positive tastes, postural support, oral stimulation, and music-based intervention.
The advance of technology and the importance of infection prevention in the neonatal setting has progressed exponentially over the course of the last few decades. As a result, parents have been somewhat forgotten and subsequently report feeling that they are on-lookers or voyeurs in their baby’s care. This builds stress and anxiety that is well documented and significant mental health issues are a real concern for parents of neonatal patients. Addressing these has not kept pace with other, more clinically based advances. Recently, however, work has begun to address these issues including the advent of Family Integrated Care (FIC). FIC is a philosophy of care that encourages parents to be central members of their baby’s care team, through a model of coaching, education and mentoring. In this chapter we address some of the more controversial areas of FIC. Parental presence in the nursery for the entire ward round causes much concern but has been managed successfully in several units for some years, as has the careful management of siblings on the unit in order to allow families to spend more time with their newborn. It is also important that staff understand the role of the nurse in supporting parents learning to care for their infant and their accountability. We hope that by outlining the key issues in each area, informed choices about how best to support parents and achieve better outcomes for the baby and their family can be made.
Aim:
To examine the association between several perinatal and obstetric risk factors and reactive attachment disorder in children diagnosed in specialized services.
Methods:
In this nested case control study, 614 cases with reactive attachment disorder and 2,423 controls matched with age and sex were identified from Finnish national registers. Conditional logistic regression was used to examine the association between a number of perinatal risk factors and reactive attachment disorder.
Results:
In the adjusted analysis, a low birthweight of <2,500 grams was associated with an increased odds of reactive attachment disorder, with an odds ratio (OR) of 1.96 and 95% confidence interval (CI) of 1.17, 3.30 and a birthweight of 4,000-4,499 grams was associated with decreased odds OR 0.49 (95% CI 0.31, 0.75). The odds for being diagnosed with reactive attachment disorder increased with a gestational age of <32 weeks OR 3.72 (95% CI 1.52, 9.10), induced labour OR 1.34 (95% CI 1.03, 1.75) and monitoring in a neonatal intensive care unit (NICU) OR 1.67 (95% CI 1.09, 2.55).
Conclusion:
We found associations between low birthweight, preterm birth, NICU admission and reactive attachment disorder. The findings add to the current literature on the understanding of the development of reactive attachment disorder in children.
Aim:
To assess, at national level, the implementation of eight principles for infant- and family-centred developmental care (IFCDC) in neonatal units. A European expert group established eight 'Principles of care' in 2018 that define neurodevelopmental and family-centred care.
Methods:
The implementation of each principle was assessed by a survey sent to level-III Spanish units. A principle was considered to be implemented if all answers to the principle-associated questions were positive.
Results:
The response rate was 84.5% (65/77). No unit had implemented eight principles. Principle 1 (free parental access) was implemented in 21.5% of the centres; Principle 2 (psychological support) 40%; Principle 3 (pain-management) 7,7%; Principle 4 (environmental influences) 29%; Principle 5 (postural support) 84.6%; Principle 6 (kangaroo-care) 67.7%; Principle 7 (breastfeeding) 23% and Principle 8 (sleep protection) in 46%. In units attending ≥50 Very Low Birth Weight (VLBW) infants four or more principles had been implemented in 31% vs. 13% <50 VLBW neonates (odds ratio 3.0 CI95% 0.9 -10.1, p0.075).
Conclusion:
The principle with the highest implementation was related to newborn body positioning. Pain management was the principle with lowest implementation. More principles for IFCDC tend to be implemented in units providing care for a higher number of VLBW infants.
Organizing an individual bank of breast milk helps to preserve an alternative possibility to continue breast-feeding of a newborn baby with pumped and (or) frozen mother’s milk. Pumped milk (milk defrosted not later than 3–6 months) is microbiologically safe food for a baby. Frozen pumped milk is much better than mixtures for babies. Sanitary Regulations and Standards 2.1.3.2630.-10 clause 3.5 are to be updated to reflect the technology of breast-feeding preservation forsick babies who do not have breast-feeding since the first days of life.
Aims
Family and Infant Neurodevelopmental Education (FINE) is a comprehensive, multidisciplinary educational pathway designed to support quality improvements in infant and family centred developmental care in neonatal services. This study aims to evaluate the impact of FINE on neonatal care in the UK.
Methods
A mixed method evaluation was based on two surveys of staff to explore perceptions of change in the care of infants, parent participation, and staff experience since the introduction of FINE. Survey 1 (S1) was conducted across a regional neonatal network where all units had sent delegates to FINE foundation courses. The Chi Squared Test was used to compare scores indicating that practice had got better, worse or stayed the same; Z numbers showed differences in perceptions between those staff who had and had not attended FINE courses. An on-line survey (S2) explored how participants from many different areas of the UK perceived the impact of FINE courses on their practice.
Results
Staff responses to Survey 1 (n = 95) indicated significant improvements in all areas of impact (p < 0.001) regardless of whether participants had (n = 33) or had not (n = 62) attended FINE courses. In general those that had attended were more positive about all areas of practice except for “infant safety” where both groups had equally positive views. Survey 2 (n = 44) mirrored these results with 70–95% of participants indicating that their practice had improved.
Conclusion
The results of this study suggest that FINE provides appropriate education for enhancing infant and family centred developmental care in neonatal units.
To compare neonatal intensive care unit policies towards parents' visiting, information, and participation in ethical decisions across eight European countries.
One hundred and twenty three units, selected by random or exhaustive sampling, were recruited, with an overall response rate of 87%.
Proportions of units allowing unrestricted parental visiting ranged from 11% in Spain to 100% in Great Britain, Luxembourg and Sweden, and those explicitly involving parents in decisions from 19% in Italy to 89% in Great Britain. Policies concerning information also varied.
These variations cannot be explained by differences in unit characteristics, such as level, size, and availability of resources. As the importance of parental participation in the care of their babies is increasingly being recognised, these findings have implications for neonatal intensive care organisation and policy.
The provision of individual rooms for NICU patients has several attractive benefits, including the ability to provide the appropriate environmental stimuli for each child, and increased privacy and accessibility for families. This concept can put serious strain on caregivers, however, by isolating them from one another and from the multiple infants for whom they may have responsibility, and places additional financial and space demands on the institution. These problems are not insurmountable, however, and use of individual rooms for at least some patients is feasible and probably desirable if certain considerations are addressed in the planning and design process.
A family-centred, developmentally supportive approach to newborn intensive care referred to as NIDCAP (Newborn Individualized Developmental Care and Assessment Programme) has caught considerable interest during recent years. In this paper we review the scientific context behind its conceptual framework and summarize our experience from 10 years of training, implementation and research. We present the short- and long-term medical and developmental outcome of our Swedish NIDCAP studies as well as attitudes of nursing staff and neonatologists. Furthermore, ethical issues and scientific obstacles concerning this concept of care are discussed.
Developmental care is the use of a range of medical and nursing interventions to decrease the stress of preterm neonates in neonatal intensive care units. This article reviews the theory underlying such interventions and research based data in different scientific fields, including neuroscience, developmental and family psychology, medicine, and nursing. The conclusion is that more research is needed.
To discover parental preferences about visiting during ward rounds.
Survey using a short structured interview
Families of babies cared for in a regional neonatal intensive care unit.
Eighty six respondents, no refusals. Sixty three had visited during a ward round, and 13 had come in especially for the round. About half had overheard conversations about other babies or thought discussions about their baby had been overheard. Concerns about these experiences were only expressed by respondents who had actually experienced overhearing. Parents and families had little information about the ward round, held diverse views, and expressed different priorities. They described a mixture of concerns about communication, practicalities, and issues of ethics and principle. Confidentiality was a matter of concern for some, but many parents expected some sharing of information between families on the unit.
Units should consider: the information they have for parents about ward rounds; the possibility that consultations may be overheard; the opportunities for parents to communicate with the clinical team.
We sought to compare guidelines for level III units in 10 European regions and analyze the characteristics of neonatal units that care for very preterm infants.
The MOSAIC (Models of Organising Access to Intensive Care for Very Preterm Births) project combined a prospective cohort study on all births between 22 and 31 completed weeks of gestation in 10 European regions and a survey of neonatal unit characteristics. Units that admitted > or = 5 infants at < 32 weeks of gestation were included in the analysis (N = 111). Place of hospitalization of infants who were admitted to neonatal care was analyzed by using the cohort data (N = 4947). National or regional guidelines for level III units were reviewed.
Six of 9 guidelines for level III units included minimum size criteria, based on number of intensive care beds (6 guidelines), neonatal admissions (2), ventilated patients (1), obstetric intensive care beds (1), and deliveries (2). The characteristics of level III units varied, and many were small or unspecialized by recommended criteria: 36% had fewer than 50 very preterm annual admissions, 22% ventilated fewer than 50 infants annually, and 28% had fewer than 6 intensive care beds. Level II units were less specialized, but some provided mechanical ventilation (57%) or high-frequency ventilation (20%) or had neonatal surgery facilities (17%). Sixty-nine percent of level III and 36% of level I or II units had continuous medical coverage by a qualified pediatrician. Twenty-two percent of infants who were < 28 weeks of gestation were treated in units that admitted fewer than 50 very preterm infants annually (range: 2%-54% across the study regions).
No consensus exists in Europe about size or other criteria for NICUs. A better understanding of the characteristics associated with high-quality neonatal care is needed, given the high proportion of very preterm infants who are cared for in units that are considered small or less specialized by many recommendations.
To promote participation by parents in the care of their child in neonatal intensive care units (NICU), health professionals need better understanding of what facilitates and what obstructs participation. The aim was to elucidate conditions for parents' participation in the care of their child in NICUs.
A field study with a hermeneutic lifeworld approach was used and data were collected at two NICUs through participative observations and interviews with representatives of management, staff and parents.
The results point to a number of contradictions in the way parents were offered the opportunity to participate in neonatal intensive care. Management and staff both had good ambitions to develop ideal care that promoted parent participation. However, the care including the conditions for parental participation was driven by the terms of the staff, routines focusing on the medical-technical care and environment, and budgetary constraints.
The result shows that tangible strategies need to be developed in NICUs aimed at optimising conditions for parents to be present and involved in the care of their child.
To explore and eamine maternal behavior in human mothers at the first postnatal contact with their young, we quantitatively analyzed photographs taken every second during the first 10 minutes of each contact. We recorded and studied this behavior in 12 mothers 1/2 to 13 1/2 hours following delivery, with their normal, full-term infants undressed and placed beside them, and in 9 other mothers during their first three tactile contacts with their premature infants (weighing 1,150 to 1,870 gm) in incubators. An orderly progression of behavior was observed in mothers of full-term infants: the mothers started with fingertip touch on the infants' extremities and proceeded in 4 to 8 minutes to massaging, encompassing palm contact on the trunk. In the first 3 minutes fingertip contact was 52%, with 28% palm contact. In the last 3 minutes of observation, fingertip contact decreased to 26% and palm contact increased to 62%. An intense interest in eye-to-eye contact was observed at the first contact. Mother-to-infant eye-to-eye contact appears to be an important exchange during the development of affectional ties. Mothers of normal premature infants permitted to touch them in the first 3 to 5 days of life followed a similar sequence, but at a much slower rate. Our results reveal suggestive evidence of species-specific behavior in human mothers at the first contact with their full-term infants and suggest that a re-evaluation is required of the present hospital policies which regulate care of the mother and infant.
This chapter presents analytic methods for matched studies with multiple risk factors of interest. We consider matched sample designs of two types, prospective (cohort or randomized) and retrospective (case-control) studies. We discuss direct and indirect parametric modeling of matched sample data and then focus on conditional logistic regression in matched case-control studies. Next, we describe the general case for matched samples including polytomous outcomes. An illustration of matched sample case-control analysis is presented. A problem solving section appears at the end of the chapter.
Present hospital regulations and the facilities for the care of high-risk infants often result in prolonged mother-infant separation, with restricted visiting and minimal physical contact. Reports of cases of child abuse and of infants who fail to thrive in the absence of organic disease reveal a disproportionately high incidence of prematurity. In the failure-to-thrive syndrome, 25 to 41% of the reported infants have been premature. Prematurity or serious illness in the newborn period resulting in maternal-infant separation was a feature in 23 to 31% of the battered infants. With such a high incidence of "mothering disorders" it is important to evaluate the mothers of high-risk infants carefully before discharge.
See table in the PDF file
Interviews with 93 mothers of 109 low birthweight infants admitted to a regional neonatal intensive care unit showed that, although 82 (88%) mothers visited on a daily basis, some families faced considerable travelling difficulties. Five families travelled more than 100 miles and three families had twin siblings in different neonatal units. Analysis of the travelling and associated expenditure strongly indicates that the parents in most need received little or no help from the statutory authorities and only 26 (28%) families received financial help from any source. There emerges a strong case for offering appropriate financial help to parents on low incomes to facilitate visiting and increase family contact.
There is growing evidence that a large number of very low birth weight infants are exhibiting neurobehavioral problems in the absence of cerebral palsy at follow-up that has extended into school age and adolescence. Many clinical factors (ie, chronic lung disease, recurrent apnea and bradycardia, transient hypothyroxemia of prematurity, hyperbilirubinemia, nutritional deficiencies, glucocorticoid exposure), as well as stressful environmental conditions, including infant-provider interaction, constant noise, and bright light, may act in combination to impact on the developing brain, even in the absence of overt hemorrhage and/or ischemia. Any potential intervention strategy designed to prevent cognitive and behavioral problems has to account for the numerous biological and clinical conditions and/or interventions, as well as postdischarge social and environmental influences.
Animal models show that developmental compensatory mechanisms may promote neural and functional plasticity
Preterm birth results in considerable disability, yet several reports suggest recovery from injury in developing brain. Developmental compensatory mechanisms may promote neural and functional plasticity, and numerous experimental studies have documented the brain’s ability to engage in regenerative mechanisms to potentially replace injured cells. We review available evidence for recovery from injury in models for the preterm brain and offer hypotheses for targeting time dependent molecular and cellular repair mechanisms that have been recently gathered from animal studies. A better understanding of these adaptive cellular and molecular mechanisms will help clinicians apply knowledge derived from animal models to clinical situations.
The many neurodevelopmental handicaps that very low birthweight infants experience suggest that preterm birth disrupts the genetically programmed pattern of brain genesis. To develop a clinically relevant model of the effect of preterm birth on developing brain, one must use an animal model that shows that the injury imposed results in neuropathological changes similar to those found in preterm infants and correlate these changes with behavioural outcomes. As in the preterm infant at the end of the second trimester, neuronal generation in the newborn rodent is complete in most regions, axonal and dendritic branching is robust, and synaptogenesis is just beginning.1
Review of the literature suggests that oxygen deprivation is a major cause of neurodevelopmental disability in preterm infants.2 Although intraventricular haemorrhage, periventricular leucomalacia, and ventriculomegaly are the most commonly recognised and best studied of these circulatory disturbances,2 hypoxia is particularly prevalent among very low birthweight infants and is a common denominator of these abnormalities.3
Models of both hypoxia-ischaemia and hypoxia have been studied in newborn rodents, and the former results in focal injury to developing brain.4 In contrast, the exposure of …
Sources of environmental stress experienced by mothers of hospitalized medically fragile infants
- Brunssen SH
Brunssen SH, Miles MS. Sources of environmental stress
experienced by mothers of hospitalized medically fragile
infants. Neonatal Netw 1996; 15: 88-9.
Conditions for parents' participation in the care of their child in neonatal intensive Greisen et al. Visiting policies in European Neonatal Intensive Care Units. ª2009 The Author(s)/Journal Compilation ª2009 Foundation Acta Paediatrica–1750 1749 care – a field study
- H Wigert
- Hellströ
- Al
- Berg
Wigert H, Hellströ m AL, Berg M. Conditions for parents' participation in the care of their child in neonatal intensive Greisen et al. Visiting policies in European Neonatal Intensive Care Units. ª2009 The Author(s)/Journal Compilation ª2009 Foundation Acta Paediatrica/Acta Paediatrica 2009 98, pp. 1744–1750 1749 care – a field study. BMC Pediatr 2008; 8: 3; doi: 10.1186/ 1471-2431-8-3.
Parental costs of neonatal visiting SUPPORTING INFORMATION Additional Supporting Information may be found in the online version of this article
- A Mcloughlin
- Vf Hillier
- Mj Robinson
McLoughlin A, Hillier VF, Robinson MJ. Parental costs of neonatal visiting. Arch Dis Child 1993; 68: 597-9.
SUPPORTING INFORMATION
Additional Supporting Information may be found in the
online version of this article:
Conditions for parents' participation in the care of their child in neonatal intensive Greisen et al. Visiting policies in European Neonatal Intensive Care Units
- H Wigert
- Al Hellströ M
- M Berg
Wigert H, Hellströ m AL, Berg M. Conditions for parents'
participation in the care of their child in neonatal intensive
Greisen et al.
Visiting policies in European Neonatal Intensive Care Units.