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Effekte von Family-Integrated Care auf zerebrale Kurzzeitmorbidität, kindliche Entwicklung und Ergebnisse der Bayley-Scales
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Background: Survival of very-low-birth-weight infants is improving in neonatology and family-centered-care might contribute to premature infants' clinical outcomes.
Aim: To evaluate a family-centered care intervention on clinical outcomes of very-low-birth-weight infants.
Methods: A quasi-experimental study was conducted in a Chinese NICU between June 2016 and June 2017. The intervention included parental education of basic care knowledge and skills followed by active participation in care for at least 4 h a day. A total of 319 very-low-birth-weight infants were recruited by convenience sampling; intervention group n = 156 and control group n = 163. Primary outcome measures were weight at discharge, length-of-stay, breastfeeding, nasal feeding, total parental nutrition, re-admission, hospital expenses. Secondary outcome measures were infant complications.
Results: Infants' weight at discharge was higher in the interventions group (2,654 g vs. 2,325 g, p < 0.001). Nutritional outcomes improved significantly: breastfeeding rate 139 vs. 91, p < 0.001; days of total parental nutrition 25 d vs. 32 d, p < 0.001; gastric feeding days 23 d vs. 35 d, p < 0.001. Length-of-stay and hospital expenses did not differ between both groups. Improved infants' complications were bronchopulmonary dysplasia (32 vs. 51, p = 0.031), retinopathy of prematurity (between groups no/mild and moderate/severe, p = 0.003), necrotizing enterocolitis (6 vs. 18, p = 0.019), and re-admission rate (21 vs. 38, p = 0.023). No differences were observed in intraventricular hemorrhage and nosocomial infections.
Conclusion: Very-low-birth-weight premature infants might experience improved clinical health outcomes when parents are present and caring from them. Family-centered care is as a beneficial care model for premature infants and should be recognized and implemented by NICUs where parents have currently limited access.
Aim
To evaluate the effects of family‐centred care on hospitalized preterm infants.
Background
With an increase in published reports on family‐centred care for preterm infants, there is a need for an up‐to‐date review and meta‐analysis of rigorously designed studies to measure the effects of family‐centred care on preterm infants.
Design
A systematic review and meta‐analysis.
Data sources
The Cochrane Library (Issue 12, 2017), PubMed (1966 to December 2017), CINAHL (1982 to December 2017), EMBASE (1974 to December 2017), and Web of Science (1975 to December 2017) databases were searched.
Review methods
Relevant terms were used to search for randomized controlled trials of family‐centred care versus standard care. A modified rating scale was utilized to assess studies for the degree of family‐centredness of the intervention.
Results
Four studies involving 1026 preterm infants were included. Compared with standard care, family‐centred care shortened the total length of hospital stay and length of neonatal intensive care unit stay. There was inadequate evidence to demonstrate any effects of family‐centred care on infant morbidity, feeding, growth, or neurobehavioural performance.
Conclusion
Family‐centred care is an effective and safe intervention to shorten the length of stay in the hospital and improve survival quality among hospitalized preterm infants.
Objective
The aim of the Integrated Family Delivered Care (IFDC) programme was to improve infant health outcomes and parent experience through education and competency-based training.
Design
In collaboration with veteran parents’ focus groups, we created an experienced co-designed care bundle including IFDC mobile application, which together with staff training programme comprised the IFDC programme. Infant outcomes were compared with retrospective controls in a prepost intervention analysis.
Main outcome measures
The primary outcome measure was the length of stay (LOS).
Results
Between April 2017 and May 2018, 89 families were recruited; 37 infants completed their entire care episode in our units with a minimum LOS >14 days. From a gestational age (GA) and birth weight-matched retrospective cohort, 57 control infants were selected. Data were also analysed for subgroup under 30 weeks GA (n=20).
Infants in the IFDC group were discharged earlier: median corrected GA (36 ⁺⁰ (IQR 35 ⁺⁰ –38 ⁺⁰ ) vs 37 ⁺¹ (IQR 36 ⁺³ –38 ⁺⁴ ) weeks; p=0.003), with shorter median LOS (41 (32–63) vs 55 (41–73) days; p=0.022). This was also evident in the subgroup <30 weeks GA (61 (39–82) vs 76 (68–84) days; p=0.035). Special care days were significantly lower in the IFDC group (30 (21–41) vs 40 (31–46); p=0.006). The subgroup of infants (<30 weeks) reached full suck feeding earlier (median: 47 (37–76) vs 72 (66–82) days; p=0.006).
Conclusion
This is the first reported study from a UK tertiary neonatal unit demonstrating significant benefits of family integrated care programme. The IFDC programme has significantly reduced LOS, resulted in the earlier achievement of full enteral and suck feeds.
Innovativer Versorgungsansatz Die Geburt eines Fruhgeborenen oder kranken
Neugeborenen ist fur Familien ein einschneidendes Ereignis. Der klinische
Behandlungspfad NeoPAss® strukturiert und kombiniert Prinzipien der
familienintegrierenden Versorgung, der psychosozialen Betreuung und des
bedarfsorientierten Fallmanagements fur die gesamte Familie. Er startet bereits
vor der Geburt, begleitet Familien in der Klinik und ebnet den Weg nach Hause.
NeoPAss® ermoglicht es den Familien, Familie zu sein – gerade mit
einem Fruhgeborenen oder kranken Neugeborenen. Hierfur wurde NeoPAss®
2015 mit dem Bayerischen Gesundheits- und Pflegepreis ausgezeichnet.
Outcome-Messung familienintegrierender Versorgungsmodelle für Frühgeborene: Ein Scoping-Review
- S Mayer-Huber