Family-Centered Care

A majority of infants admitted into the neonatal intensive care unit (NICU) are premature infants born before 37 weeks gestational age. The hospitalization of preterm babies is often associated with grief, loss, anxiety and helplessness for parents [1]. Parents are physically separated from their child when the infant is in an isolette and may feel less connected to the baby when they are in the care of NICU staff. Compared to full term babies, preterm infants are also at a much greater risk for neurological and behavioral developmental delays [2]. These factors, among others, can disrupt the emotional connection between parents and their child, which can have long term effects on both and influence the trajectory of the infants development [3].

Family-centered care is an approach in the NICU that focuses on including the family in an infants care as much as possible. The hope of family-centered care is to counteract the adverse effects that the NICU environment can have on both the child and parents. It involves the NICU staff recognizing the unique vulnerabilities, strengths, and values of the family and taking action to provide training, resources and information. This requires mutual trust and respect between the family and NICU staff, built on honest and open communication and the mutual understanding that a familys involvement in their childs care is critical [4]. Through essential parental involvement, family-centered care positively influences an infants long term outcomes.

Studies from other countries show that family-centered care is associated with lower parental stress and improved infant weight gain [5]. Since the United States has unique social contexts and challenges regarding parental leave compared to other countries, it is important to study the potential impact of and challenges to implementing family-centered care in this country [4].

In family-centered care, various interactive techniques are used to enable parent participation and strengthen the parent-infant relationship. For example, scent cloth exchange, maternal vocalization, skin-to-skin contact, and other family-based support sessions can reinforce a strong mother-child bond while in the NICU [1]. A family-centered care approach can lead to increased rates of breastfeeding, which can minimize the risks of certain medical complications and provide immunity to a NICU baby; this may also be related to improvements in infant weight gain before discharge [5]. Additionally, adaptation of family-centered care in the NICU can improve social, attention and neurodevelopmental outcomes for NICU babies at 18 months of age, thus addressing one of the biggest issues that premature infants face later in life [6]. The benefits of family-centered care are not solely for the baby; this type of NICU care can diminish maternal stress, improve confidence and feelings of competence and enhance maternal identity [7]. Unfortunately, data regarding the most effective methods for implementing family-centered interventions remains lacking in the United States.

Especially in the United States, there are a number of challenges that implementation of a family-centered care approach faces. All NICU parents must balance life responsibilities, such as maintaining a living wage and caring for siblings, while also supporting a baby in the hospital. This can create strain on emotional and financial family health and may lead to reduced visitation by NICU parents. As the cornerstone to a family-centered care approach, the lack of parental visitation in U.S. NICUs presents a major challenge to the approach succeeding [8]. The execution of a family-centered approach also requires considerable communication, patience, and repetition from the NICU staff. Increasing the number of nurses and the type of their training could potentially improve the likelihood that a family-centered care approach would thrive [3].

Evidence for the efficacy of family-centered care remains lacking in the United States due to low patient participation in research and a lack of randomized controlled clinical trials [2]. However, implementation of this approach in international studies has shown great promise. Future studies should investigate hurdles to parent visitation, post-NICU outcomes, father-child relationships, and outcomes based on the quality, not just quantity, of child-parent interactions.

 

References:
[1] Hane AA, Myers MM, Hofer MA, Ludwig RJ, Halperin MS, Austin J, Glickstein SB, Welch MG. Family nurture intervention improves the quality of maternal caregiving in the neonatal intensive care unit: evidence from a randomized controlled trial. J Dev Behav Pediatr. 2015 Apr;36(3):188-96. doi: 10.1097/DBP.0000000000000148. PMID: 25757070.

[2] Welch CD, Check J, O’Shea TM. Improving care collaboration for NICU patients to decrease length of stay and readmission rate. BMJ Open Qual. 2017 Oct 21;6(2):e000130. doi: 10.1136/bmjoq-2017-000130. PMID: 29450288; PMCID: PMC5699126.

[3] Bry A, Wigert H. Psychosocial support for parents of extremely preterm infants in neonatal intensive care: a qualitative interview study. BMC Psychol. 2019 Nov 29;7(1):76. doi: 10.1186/s40359-019-0354-4. PMID: 31783784; PMCID: PMC6883543.

[4] Sigurdson, Krista, Jochen Profit, Ravi Dhurjati, Christine Morton, Melissa Scala, Lelis Vernon, Ashley Randolph, Jessica T. Phan, and Linda S. Franck. 2020. Former NICU Families Describe Gaps in Family-Centered Care. Qualitative Health Research 30 (12): 186175. doi:10.1177/1049732320932897.

[5] Klawetter S, Greenfield JC, Speer SR, Brown K, Hwang SS. An integrative review: maternal engagement in the neonatal intensive care unit and health outcomes for U.S.-born preterm infants and their parents. AIMS Public Health. 2019 May 5;6(2):160-183. doi: 10.3934/publichealth.2019.2.160. PMID: 31297402; PMCID: PMC6606523.

[6] Welch MG, Firestein MR, Austin J, Hane AA, Stark RI, Hofer MA, Garland M, Glickstein SB, Brunelli SA, Ludwig RJ, Myers MM. Family Nurture Intervention in the Neonatal Intensive Care Unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial. J Child Psychol Psychiatry. 2015 Nov;56(11):1202-11. doi: 10.1111/jcpp.12405. Epub 2015 Mar 11. PMID: 25763525.

[7] Treyvaud K, Spittle A, Anderson PJ, O’Brien K. A multilayered approach is needed in the NICU to support parents after the preterm birth of their infant. Early Hum Dev. 2019 Dec;139:104838. doi: 10.1016/j.earlhumdev.2019.104838. Epub 2019 Aug 27. PMID: 31471000.

[8] Pineda R, Bender J, Hall B, Shabosky L, Annecca A, Smith J. Parent participation in the neonatal intensive care unit: Predictors and relationships to neurobehavior and developmental outcomes. Early Hum Dev. 2018 Feb;117:32-38. doi: 10.1016/j.earlhumdev.2017.12.008. Epub 2017 Dec 21. PMID: 29275070; PMCID: PMC5856604.

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