1
|
Zhang Y, Jiang M, Wang S, Xiang X, He W, Du J, Hei M. Effect of family integrated care on stress in mothers of preterm infants: A multicenter cluster randomized controlled trial. J Affect Disord 2024; 350:304-312. [PMID: 38232775 DOI: 10.1016/j.jad.2024.01.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/23/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Reducing mother-infant separation in early life is a key breakthrough in the care improvement model in the neonatal intensive care unit (NICU). Previously, we reported effect of family integrated care (FICare) on clinical outcomes of preterm infants. We further clarify effect of FICare on maternal stress. METHODS Mothers of preterm infants at eleven NICUs were randomized to the FICare group and the control group. The primary outcome was the reduction in Parental Stress Scale: NICU (PSS:NICU) score from enrollment to discharge. RESULTS Total of 601 mothers (298 in FICare and 303 in control groups) enrolled. There was no significant difference in PSS:NICU score between the 2 groups at enrollment (P = 0.824), and the FICare group had lower scores at discharge (P < 0.001). PSS:NICU scores of both groups were significantly decreased at discharge compared to at enrollment (P < 0.001), and the reduction was greater in the FICare group (P < 0.001). After applying linear regressions to adjust for potential confounders, results remained unchanged (adjusted P < 0.001). PSS:NICU score reductions from enrollment to discharge were positively correlated with maternal age in the control group (ρ = 0.147, P = 0.011). LIMITATIONS This study was limited to post-hoc analyses and did not include follow-up to evaluate long-term effects. CONCLUSIONS FICare is helpful for reducing maternal stress in preterm infants in the NICU. Older mothers tend to have limited improvements in stress after traditional nonparent care, which suggests that they may benefit more from the FICare model.
Collapse
Affiliation(s)
- Yuan Zhang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China
| | - Min Jiang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China
| | - Shu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiying Xiang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China
| | - Wenwen He
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China
| | - Juan Du
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China
| | - Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center for Children's Health, Beijing, China.
| |
Collapse
|
2
|
Piris-Borregas S, Bellón-Vaquerizo B, Muñoz-López O, Cuadrado-Obregón N, Melchor-Muñoz P, Niño-Díaz L, González-Mora FJ, Barroso-Santiago M, Martín-Arriscado C, Pallás-Alonso CR. Parents who spent more hours in intensive care units with their low birthweight newborn infant did not achieve autonomous care faster. Acta Paediatr 2023; 112:2104-2112. [PMID: 37332100 DOI: 10.1111/apa.16878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 06/20/2023]
Abstract
AIM We examined the correlation between how long it took the parents of very low birthweight infants, born weighing up to 1500 g, to provide different kinds of autonomous care in a neonatal intensive care unit (NICU). METHODS This prospective observational was conducted in the NICU of a Spanish hospital from 10 January 2020 to 3 May 2022. The unit had 11 beds single-family rooms and provided eight beds in an open bay room. The study examined breastfeeding, patient safety, participation in rounds, pain prevention and cleanliness. RESULTS We studied 96 patients and their parents and there was no correlation between any type of care and the time it took parents to provide it autonomously. Parents in the single-family room cohort spent a median of 9.5 h per day between them in the NICU, while the parents in the open bay room spent 7.0 h with their infants (p = 0.03). However, parents in the single-family room group were able to recognise pain faster (p = 0.02). CONCLUSION Parents in single-family rooms spent more time in the NICU and recognised pain faster but did not achieve autonomous care faster than parents in the open bay group.
Collapse
Affiliation(s)
- Salvador Piris-Borregas
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | | | - Olga Muñoz-López
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | - Lidia Niño-Díaz
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | - Carmen Rosa Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| |
Collapse
|
3
|
Yu Y, Liu Q, Xiong X, Luo Y, Xie W, Song W, Fu M, Yang Q, Yu G. Breastfeeding needs of mothers of preterm infants in China: a qualitative study informed by the behaviour change wheel. Int Breastfeed J 2023; 18:50. [PMID: 37658411 PMCID: PMC10472562 DOI: 10.1186/s13006-023-00587-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Although breastfeeding is strongly recommended, the breastfeeding rate of preterm infants in China remains significantly low. In addition to the global structural challenges to breastfeeding and the physiological immaturity of preterm infants, Chinese mothers of preterm infants face unique challenges of maternal-infant separation after birth. Moreover, little is known about Chinese mothers' specific needs in coping with the difficulties posed by these challenges. This study utilized the Behaviour Change Wheel to investigate the breastfeeding needs of Chinese preterm mothers that may facilitate its practice in the future. METHOD A qualitative descriptive design was implemented in Wuhan in 2022. Based on purposeful sampling, 13 preterm mothers were recruited from a NICU in a Grade III Class A hospital in Wuhan, China. Face-to-face semi-structured interviews were conducted to collect data using the interview guide developed by the Theoretical Domains Framework. Theoretical Thematic Analysis was used to review the data in 6 steps to identify themes. RESULTS Five major themes emerged: (1) capability: ability to interpret infants' cues and identify problems, and need for breastfeeding knowledge and skills training; (2) physical opportunity: cleanliness and quietness in household environment, private lactation spaces and breastfeeding tools in workplaces and hospitals; (3) social opportunity: family support, peer support, and authoritative support from healthcare providers; (4) reflective motivation: information on health impacts of breastfeeding; (5) automatic motivation: maternal-infant bonding, free of aversive stimulus. CONCLUSION Preterm mothers' needs to enable breastfeeding were diverse, including increasing their capability, physical and social opportunities, and reflective and automatic motivation. People, resources and environments associated with these needs should be engaged together to stablish a conducive structural environment for breastfeeding. The policy change for "zero separation" and implementation of kangaroo care should also be implemented in Chinese neonatal intensive care units. Future studies are needed to design effective interventions according to mothers' specific needs.
Collapse
Affiliation(s)
- Yaqi Yu
- Nursing Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, China
| | - Qianru Liu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, China
- Nursing Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277, Jiefang Avenue, Wuhan, China
| | - Xiaoju Xiong
- Nursing Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, China
| | - Ying Luo
- Nursing Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, China
| | - Wen Xie
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, China
| | - Wenshuai Song
- Nursing Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, China
| | - Maoling Fu
- Nursing Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, China
| | - Qiaoyue Yang
- Nursing Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, China
| | - Genzhen Yu
- Nursing Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, China.
| |
Collapse
|
4
|
Franck LS, Gay CL, Hoffmann TJ, Kriz RM, Bisgaard R, Cormier DM, Joe P, Lothe B, Sun Y. Maternal mental health after infant discharge: a quasi-experimental clinical trial of family integrated care versus family-centered care for preterm infants in U.S. NICUs. BMC Pediatr 2023; 23:396. [PMID: 37563722 PMCID: PMC10413600 DOI: 10.1186/s12887-023-04211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Involvement in caregiving and tailored support services may reduce the risk of mental health symptoms for mothers after their preterm infant's neonatal intensive care unit (NICU) discharge. We aimed to compare Family-Centered Care (FCC) with mobile-enhanced Family-Integrated Care (mFICare) on post-discharge maternal mental health symptoms. METHOD This quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from three NICUs into sequential cohorts: FCC or mFICare. We analyzed post-discharge symptoms of perinatal post-traumatic stress disorder (PTSD) and depression using intention-to-treat and per protocol approaches. RESULTS 178 mothers (89 FCC; 89 mFICare) completed measures. We found no main effect of group assignment. We found an interaction between group and stress, indicating fewer PTSD and depression symptoms among mothers who had higher NICU-related stress and received mFICare, compared with mothers who had high stress and received FCC (PTSD: interaction β=-1.18, 95% CI: -2.10, -0.26; depression: interaction β=-0.76, 95% CI: -1.53, 0.006). Per protocol analyses of mFICare components suggested fewer PTSD and depression symptoms among mothers who had higher NICU stress scores and participated in clinical team rounds and/or group classes, compared with mothers who had high stress and did not participate in rounds or classes. CONCLUSION Overall, post-discharge maternal mental health symptoms did not differ between the mFICare and FCC groups. However, for mothers with high levels of stress during the NICU stay, mFICare was associated with fewer post-discharge PTSD and depression symptoms.
Collapse
Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA.
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, Office of Research, School of Nursing, UCSF, San Francisco, CA, USA
| | - Rebecca M Kriz
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA
| | - Robin Bisgaard
- Intensive Care Nursery, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Diana M Cormier
- NICU and Pediatrics, Community Regional Medical Center, Fresno, CA, USA
| | - Priscilla Joe
- Division of Neonatology, UCSF Benioff Children's Hospital, Oakland, CA, USA
| | | | - Yao Sun
- Division of Neonatology, Department of Pediatrics, UCSF, San Francisco, CA, USA
| |
Collapse
|
5
|
Ansari NS, Franck LS, Tomlinson C, Colucci A, O’Brien K. A Pilot Study of Family-Integrated Care (FICare) in Critically Ill Preterm and Term Infants in the NICU: FICare Plus. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1337. [PMID: 37628336 PMCID: PMC10453905 DOI: 10.3390/children10081337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023]
Abstract
Family-integrated care (FICare) is associated with improved developmental outcomes and decreased parental mental health risks in stable preterm infants. However, less is known about its application in critically ill infants who are at greater risk for adverse outcomes. The objective of this study was to assess the safety and feasibility of implementation of an augmented FICare program, FICare Plus, in critically ill infants in the first few weeks of life. Resources were specifically developed for staff and parents to support earlier parental engagement in infant care. Infant health outcomes and standardized measures of parental stress, anxiety and parenting self-efficacy were also collected using standardized questionnaires: State -Trait Anxiety Inventory (STAI), Parental Stressor Scale: NICU (PSS: NICU), Perceived Parenting Self-Efficacy Tool and Family Centered Care Survey. The t-test or Wilcoxon rank-sum test were used to compare continuous variables, while the Chi-square or Fisher exact test were used for categorical variables, respectively. In this prospective cohort study, 41 critically ill infants were enrolled: 17 in standard care (SC) and 24 in the FICare Plus group. The tools and procedures developed for FICare Plus successfully supported greater engagement in the care of their infants with no increase in adverse events and no increase in parental stress. Parents in the FICare Plus cohort felt confident to participate in their infant's care. The staff also found this model of care acceptable and well adopted. Preliminary measures of infant efficacy were similar in both groups. Total anxiety scores were high among all parents at enrollment (87 (67-94) vs. 70.5 (66-86); p-value 0.22). However, the scores prior to discharge were lower in FICare Plus group (78 (71-90) vs. 63 (52-74.5); p-value 0.02). This pilot study showed that it is feasible and safe to implement family-integrated care in critically ill infants.
Collapse
Affiliation(s)
- Najmus Sehr Ansari
- Department of Pediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada; (C.T.); (K.O.)
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Linda S. Franck
- School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Christopher Tomlinson
- Department of Pediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada; (C.T.); (K.O.)
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Anna Colucci
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada;
| | - Karel O’Brien
- Department of Pediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada; (C.T.); (K.O.)
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada;
| |
Collapse
|
6
|
Zhang Y, Jiang M, Xiang X, He W, Du J, Hei M. Effect of Family Integrated Care on maternal stress in preterm infants in the Neonatal Intensive Care Unit: A bi-center experience. Asia Pac Psychiatry 2023; 15:e12521. [PMID: 36502821 DOI: 10.1111/appy.12521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
AIM To compare the effect of family integrated care (FICare) on maternal stress in preterm infants with traditional non-parent neonatal intensive care unit (NICU) care. METHODS We continuously enrolled mothers and their preterm infants from two NICUs between August 2014 and April 2017; while one NICU applied the FICare model (FICare group) and the other performed standard non-parent care model (control group). Maternal stress was evaluated by the Parental Stress Scale: NICU (PSS: NICU) on admission and right before the discharge. A generalized linear model to adjust for potential confounders. Subgroup analysis was also performed for comparisons between two groups. RESULTS A total of 215 mothers with preterm infants were included in this study, among whom 118 (54.88%) were in FICare group and 97 (45.12%) were in control group. The mean PSS: NICU score was 117.36 ± 26.27 on admission with no difference between two groups. Before being discharged home, the PSS: NICU score of parents in both groups was significantly reduced, with the score of FICare group was significantly lower than that of control group. In all sub-domains of PSS: NICU score as sights and sounds, baby looks and behavior score, and parental role, the scores of FICare group were significantly lower than control group. CONCLUSIONS There was a simultaneous decrease of maternal stress for NICU preterm infants. FICare further facilitates reducing the maternal stress. It shall be encouraged to apply FICare model in NICUs.
Collapse
Affiliation(s)
- Yuan Zhang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,National Center of Children's Health, Beijing, China
| | - Min Jiang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,National Center of Children's Health, Beijing, China
| | - Xiying Xiang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,National Center of Children's Health, Beijing, China
| | - Wenwen He
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,National Center of Children's Health, Beijing, China
| | - Juan Du
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,National Center of Children's Health, Beijing, China
| | - Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,National Center of Children's Health, Beijing, China
| |
Collapse
|
7
|
NICU Staff's Perceptions and Attitudes Toward the Family Integrated Care (FICare) Model: A Chinese Cross-sectional Study. Adv Neonatal Care 2022; 22:456-466. [PMID: 34743111 DOI: 10.1097/anc.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Family Integrated Care (FICare) is an innovative model that encourages parents to assume the role of primary caregivers during the neonatal period. PURPOSE To conduct a survey of neonatal intensive care unit (NICU) nurses and physicians on a national scale to determine their perceptions and attitudes toward FICare. METHODS Data on 3 domains were collected: demographic characteristics, FICare perceptions, and attitudes. The survey included 299 NICU nurses and physicians from 31 tertiary-level NICUs across China (response rate = 96.5%). RESULTS The respondents showed a positive attitude toward implementing FICare and recognized its positive impact on infants. However, some respondents raised concerns regarding its feasibility and limitations of the NICU setting. The respondents' perceptions and attitudes of FICare varied based on their personal characteristics, such as marital status and day/night work shifts. IMPLICATIONS FOR PRACTICE AND RESEARCH Most NICU nurses and physicians reported that FICare can benefit infants. Despite some constraints related to the NICU environmental conditions, most NICU leaders felt positive about implementing FICare in China. Therefore, establishing key strategies for performing FICare, selecting appropriate personnel, and educating the staff regarding FICare are useful approaches to promote FICare implementation. FICare requires the team's collaborative effort with the support of NICU leaders to overcome system and setting barriers. Nurses should serve as navigators to guide its implementation. More studies on healthcare setting policies, parents' perceptions, and approaches for healthcare professionals to perform FICare in China are required.
Collapse
|
8
|
Liang X, Miao A, Zhang W, Li M, Xing Y. Effect of family integrated care on physical growth and language development of premature infants: a retrospective study. Transl Pediatr 2022; 11:965-977. [PMID: 35800279 PMCID: PMC9253945 DOI: 10.21037/tp-22-210] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/27/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Premature birth (PTB) increases the long-term risk of diseases such as hypertension, heart disease, and diabetes in adulthood. It is an independent disease with the largest global burden in terms of high mortality and lifelong negative health impacts. The purpose of this study was to analyze the physical growth and language development of premature infants (PIs) at the age of 18 months, and to explore the impact of family integrated care (FIcare) on PI. METHODS This study retrospectively included mothers and their PIs born in the Neonatal Pediatrics Department, Affiliated Hospital of Nantong University from January 2018 to September 2020 and hospitalized in the neonatal intensive care unit (NICU) within 24 hours after birth. The weight, head circumference, body length, and language development of each child were followed up at the age of 1, 3, 6, 12, and 18 months and recorded, and the relationship between FIcare and physical growth and language development of PIs was evaluated. RESULTS The development quotient (DQ) score and language development score of the FIcare group were always higher than those of the control group from 6 to 18 months, and the difference was statistically significant (P<0.05). Multiple regression analysis showed that the body length of the FIcare group participants was longer than that of control group participants. The head circumference of infants was positively correlated with gestational age, birth head circumference, and family average monthly income. The head circumference of FIcare group participants was longer than that of control group participants. The DQ score was positively correlated with gestational age, and the FIcare group participants scored higher than control group participants. Logistic regression analysis showed that early language milestone (ELM) scale score and gestational age were positively correlated with mother's education, and the score of FIcare group participants was higher than that of control group participants (P<0.05). CONCLUSIONS Compared with the traditional nursing model, the implementation of FIcare for the hospitalized PIs in the NICU can actively promote the physical growth and language development of infants.
Collapse
Affiliation(s)
- Xiangyan Liang
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Aimei Miao
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Wei Zhang
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Min Li
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Yan Xing
- Department of Neonatal Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| |
Collapse
|
9
|
Hei M, Li X, Shi Y, Cao Y, Sun J, Wu H, Jiang S, Ma X, Wang Y, Sun H, Zhang H, Du LZ, Zhou W, Lee SK, Chen C. Chinese Neonatal Network: a national protocol for collaborative research and quality improvement in neonatal care. BMJ Open 2022; 12:e051175. [PMID: 35501095 PMCID: PMC9062799 DOI: 10.1136/bmjopen-2021-051175] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The objective of the Chinese Neonatal Network (CHNN) is to provide a platform for collaborative research, outcomes evaluation and quality improvement for preterm infants with gestational age less than 32 weeks in China. The CHNN is the first national neonatal network and has the largest geographically representative cohort from neonatal intensive care units (NICUs) in China. METHODS AND ANALYSIS Individual-level data from participating NICUs will be collected using a unique database developed by the CHNN on an ongoing basis from January 2019. Data will be prospectively collected from all infants <32 weeks gestation or <1500 g birth weight at 58 participating NICUs. Infant outcomes and inter-institutional variations in outcomes will be examined and used to inform quality improvement measures aimed at improving outcomes. Information about NICU environmental and human resource factors and processes of neonatal care will also be collected and analysed for association with outcomes. Clinical studies, including randomised controlled trials will be conducted using the CHNN data platform. ETHICS AND DISSEMINATION This study was approved by the ethics review board of Children's Hospital of Fudan University, which was recognised by all participating hospitals. Waiver of consent were granted at all sites. Only non-identifiable patient level data will be transmitted and only aggregate data will be reported in CHNN reports and publications.
Collapse
Affiliation(s)
- Mingyan Hei
- Neonatal Center, Beijing Children's Hospital Capital Medical University, Beijing, China
- Neonatal Center, National Center for Children's Health, Beijing, China
| | - Xiaoying Li
- Department of Neonatology, Qilu Children's Hospital of Shandong University, Jinan, Shandong, China
| | - Yuan Shi
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yun Cao
- Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Jianhua Sun
- Department of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wu
- Neonatology, The First Bethune Hospital of Jilin University, Changchun, Jilin, China
| | - Siyuan Jiang
- Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaolu Ma
- Neonatology, The Children's Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanchen Wang
- Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Huiqing Sun
- Division of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
- Children's Hospital of Henan Zhengzhou, Zhengzhou, China
| | - Huayan Zhang
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Li-Zhong Du
- The Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Wenhao Zhou
- Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Shoo K Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Chao Chen
- Neonatology, Children's Hospital of Fudan University, Shanghai, China
| |
Collapse
|
10
|
Dong D, Ru X, Huang X, Sang T, Li S, Wang Y, Feng Q. A prospective cohort study on lactation status and breastfeeding challenges in mothers giving birth to preterm infants. Int Breastfeed J 2022; 17:6. [PMID: 35012631 PMCID: PMC8751123 DOI: 10.1186/s13006-021-00447-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Mothers of preterm infants face many challenges in breastfeeding, especially regarding lactation. This study aimed to investigate the lactation status and challenges in breastfeeding faced by preterm infants’ mothers. Methods We approached 124 mothers who gave birth to preterm infants between 26 May and 31 October 2018 in a tertiary hospital in China. Lactation status and challenges in breastfeeding on day 7 postpartum, at discharge of infants, 2 weeks post-discharge, and 3 months of corrected age were collected using questionnaires. The area under the receiver operating characteristic (ROC) curve for expressed milk volume on day 7 postpartum for predicting expressed milk volume ≥ 300 mL/d at discharge was calculated. Logistic regression analyses were performed to identify factors associated with delayed lactogenesis II onset and continuation of breastfeeding at 3 months of corrected age. Results Seventy mothers were enrolled, and 51.4% had delayed lactogenesis II. Multivariate logistic regression analysis revealed that older maternal age (aOR = 1.19; 95% CI: 1.01, 1.40) and first live birth (aOR = 4.81; 95% CI 1.43, 16.18) were significant independent predictors of delayed lactogenesis II. Mothers with delayed lactogenesis II had significantly lower expressed milk volume (day 7 postpartum: 160.0 mL vs. 300.0 mL, U = 328.50, p = 0.001; at discharge: 425.0 mL vs. 612.5 mL, U = 372.00, p = 0.005), with a lower proportion of exclusive breastfeeding in their infants (at discharge: 33.3% vs. 69.8%, χ2 = 12.39, df = 1, p < 0.001; 3 months of corrected age: 17.8% vs. 52.8%, χ2 = 11.03, df = 1, p = 0.001). The ROC showed that expressed milk volume > 190 mL/d on day 7 postpartum significantly predicted expressed milk volume ≥ 300 mL/d at discharge. Insufficient human milk was the main reason for breastfeeding discontinuation at 3 months of corrected age. Twins were less likely to continue breastfeeding at 3 months of corrected age (aOR = 0.27; 95% CI 0.09, 0.86). In singleton infants, mother’s own milk ≥50% of total milk uptake at 2 weeks post-discharge (aOR = 32.66; 95% CI 3.00, 355.25) was an independent predictor of continuous breastfeeding at 3 months of corrected age. Feeding complications in infants, poor breastfeeding technique, and low milk output are the main challenges in breastfeeding. Conclusion Interventions to improve early postpartum lactation and breastfeeding techniques may increase breastfeeding adoption in mothers of preterm infants. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00447-4.
Collapse
Affiliation(s)
- Dingding Dong
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Xifang Ru
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Xiaofang Huang
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Tian Sang
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Shan Li
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Ying Wang
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Qi Feng
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China.
| |
Collapse
|
11
|
Smith VC. Discharge planning considerations for the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2021; 106:442-445. [PMID: 33046524 DOI: 10.1136/archdischild-2019-318021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/21/2020] [Indexed: 11/04/2022]
Abstract
Neonatal intensive care unit (NICU) discharge readiness is the primary caregivers' masterful attainment of technical care skills and knowledge, emotional comfort and confidence with infant care by the time of discharge. NICU discharge preparation is the process of facilitating discharge readiness. Discharge preparation is the process with discharge readiness as the goal. Our previous work described the importance of NICU discharge readiness and strategies for discharge preparation from an American medical system perspective. NICU discharge planning is, however, of international relevance as challenges in relation to hospital discharge are a recurring global theme. In this manuscript, we conceptualise NICU discharge preparation with international perspective.
Collapse
Affiliation(s)
- Vincent C Smith
- Pediatrics Division of Newborn Medicine, Boston Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Wang Y, Zhao T, Zhang Y, Li S, Cong X. Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants. Breastfeed Med 2021; 16:282-291. [PMID: 33533688 DOI: 10.1089/bfm.2020.0358] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background and Objectives: Kangaroo mother care (KMC) benefits preterm infants' health through increasing breastfeeding, but the longitudinal effects of KMC remain unknown. This study investigates the impact of KMC on breastfeeding and health outcomes in Chinese preterm infants. Methods: A longitudinal randomized controlled study was conducted with 79 preterm infant-mother dyads. The KMC group (n = 36) was provided 2.5 hours/day KMC during the neonatal intensive care unit (NICU) hospitalization, while the control group (n = 43) received standard care. Infant's feeding regimens and physical growth were documented daily at NICU. Physical growth and Neonatal Behavioral Neurological Assessment were measured at 40 weeks, 3 months, and 6 months of corrected age (CA). Breastfeeding outcomes were documented at 6 months of CA. Results: Compared with the control group, KMC infants received higher mothers' milk proportion during hospitalization (B = 0.16, confidence interval [CI] = [0.11-0.21]) and less feeding intolerance at discharge (odds ratio [OR] = 0.11, CI = [0.02-0.43]); and higher exclusive breastfeeding proportion (OR = 14.6, CI = [3.5-60.9]) at 6 months CA. KMC infants also had significant increased body weight and body length at hospital discharge; and more increases of body weight, body length, and head circumference in follow-ups. The neurobehavioral score was also higher in the KMC group compared to the control group over time. Conclusions: Longitudinal KMC effects are significant in promoting preterm infants' breastfeeding outcomes, growth, and neurodevelopment. Early initiation of KMC practice is highly recommended to the parent-infant population in Chinese NICUs to promote breastfeeding and developmental outcomes.
Collapse
Affiliation(s)
- Ying Wang
- Department of Neonatal Intensive Care Unit, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Tingting Zhao
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Yiming Zhang
- Department of Statistics; University of Connecticut, Storrs, Connecticut, USA
| | - Siying Li
- Department of Neonatal Intensive Care Unit, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| |
Collapse
|
13
|
Hei M, Gao X, Li Y, Gao X, Li Z, Xia S, Zhang Q, Han S, Gao H, Nong S, Zhang A, Li J, Wang Y, Ye XY, Lee SK. Family Integrated Care for Preterm Infants in China: A Cluster Randomized Controlled Trial. J Pediatr 2021; 228:36-43.e2. [PMID: 32898578 DOI: 10.1016/j.jpeds.2020.09.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To explore whether family integrated care (FICare) is feasible and improves the outcomes of preterm infants in China. STUDY DESIGN This was a multicenter prospective cluster-randomized controlled trial comparing FICare and standard care. The primary outcome was length of stay (LOS). Secondary outcomes were nosocomial infections, duration of supplemental oxygen, breastfeeding, and weight gain. Outcomes were compared using univariate and multivariable analyses adjusted for potential confounders and clustering. RESULTS We enrolled 601 preterm infants from 11 neonatal intensive care units (FICare, n = 298; control, n = 303). The unadjusted LOS was 30.81 vs 30.26 days (mean ratio, 1.02; 95% CI, 0.85-1.22; P = .85). After adjustment, outcomes in the FICare group were improved compared with the control group, including LOS (28.26 vs 35.04 days; mean ratio, 0.81; 95% CI, 0.72-0.91), total medical expenditures (mean ratio, 0.69; 95% CI, 0.53-0.90), weight gain velocity (15.73 vs 10.30 g/day; mean difference, 5.43; 95% CI, 3.65-7.21), duration of supplemental oxygen (13.11 vs 21.42 days; mean difference, 0.71; 95% CI, 0.50-1.00), nosocomial infection rates (4.13 vs 5.84/1000 hospital days; mean ratio, 0.67; 95% CI, 0.47-0.96), antibiotic exposure (38.63 vs 57.32/100 hospital days; mean ratio, 0.67; 95% CI, 0.47-0.96), breastfeeding rates (87.25% vs 55.78%; OR, 5.42; 95% CI, 3.25-9.05), and rehospitalization rates (3.65% vs 7.48%; OR, 0.47; 95% CI, 0.28-0.77). At follow-up to 18 months, breastfeeding rates and weight were significantly (P < .05) higher over time in the FICare group. CONCLUSIONS FICare was feasible in Chinese neonatal intensive care units and was associated with reduced hospital LOS, medical expenditures, and rates of adverse outcomes.
Collapse
Affiliation(s)
- Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center of Children's Health, Beijing, China.
| | - Xiangyu Gao
- Department of Pediatrics, Southeast University Affiliated Xuzhou Hospital, Xuzhou, Jiangsu, China
| | - Ying Li
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xirong Gao
- Department of Neonatology, Hunan Children's Hospital, Changsha, Hunan, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women and Children's Hospital, Xi'an, Shaanxi, China
| | - Shiwen Xia
- Department of Neonatology, Hubei Province Women and Children Hospital, Wuhan, Hubei, China
| | - Qianshen Zhang
- Department of Neonatology, Shenzhen Maternal and Childcare Hospital, Shenzhen, Guangdong, China
| | - Shuping Han
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Hongxia Gao
- Department of Neonatology, Gansu Provincial Maternity and Childcare Hospital, Lanzhou, Gansu, China
| | - Shaohan Nong
- Department of Pediatrics, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Aimin Zhang
- Department of Neonatology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Jia Li
- Department of Neonatology, Kunming Maternal and Child Healthcare Hospital, Kunming, Yunnan, China
| | - Yanchen Wang
- Chinese Neonatal Network, Fudan Children's Hospital, Shanghai, China
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Yang M, Du J, Yang Q, Dou W, Jiang M, Hei M. Influence of Family Integrated Care on the Intestinal Microbiome of Preterm Infants With Necrotizing Enterocolitis and Enterostomy: A Preliminary Study. Front Pediatr 2021; 9:678254. [PMID: 34900854 PMCID: PMC8662560 DOI: 10.3389/fped.2021.678254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to investigate the influence of family integrated care (FICare) on the intestinal microbiome of preterm infants with necrotizing enterocolitis and enterostomy. This was a prospective pilot study at Beijing Children's Hospital. Premature infants with an enterostomy who met the enrollment criteria were divided into the 2-week FICare and non-FICare groups (non-randomly). We collected their fecal samples and subjected the intestinal microbiomes to 16S rRNA gene sequencing. Operational taxonomic units (OTU) were analyzed to assess the intestinal microbiome richness, and we then carried out α-diversity, β-diversity, and species clustering analyses and a linear discriminant analysis (LDA) effect size (LEfSe) analysis to identify the differences in the microbial communities between the two groups. There were 12 patients enrolled in the study (FICare, n = 7; non-FICare, n = 5). There were no significant between-group differences in demographic characteristics, or in the relative abundances of phyla and genera. The major bacterial phyla were Proteobacteria, Firmicutes, and Actinobacteria, and Serratia, Enterococcus, Cronobacter, and Bifidobacterium dominated at the genus level. The α-diversity analysis indicated that the intestinal flora was more diverse in the non-FICare group than the FICare group (p < 0.05). However, most of the other indicators did not suggest a difference between the two groups. There was a high proportion of shared OTUs between the two groups, and the PCoA and clustering analyses indicated that the two groups were difficult to distinguish, indicating that the intestinal microbiomes were relatively similar between the groups. In summary, short-term FICare had no significant positive effect on the establishment of intestinal flora diversity in premature infants with necrotizing enterocolitis and enterostomy. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-OPN-17011801).
Collapse
Affiliation(s)
- Mengyang Yang
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| | - Juan Du
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| | - Qin Yang
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| | - Wenyan Dou
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| | - Min Jiang
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| | - Mingyan Hei
- Department of Neonatology, Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, China
| |
Collapse
|
15
|
Moreno-Sanz B, Montes MT, Antón M, Serrada MT, Cabrera M, Pellicer A. Scaling Up the Family Integrated Care Model in a Level IIIC Neonatal Intensive Care Unit: A Systematic Approach to the Methods and Effort Taken for Implementation. Front Pediatr 2021; 9:682097. [PMID: 34178899 PMCID: PMC8219911 DOI: 10.3389/fped.2021.682097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Family Integrated Care (FICare) integrates parents in the direct care of their child while the healthcare personnel act as teachers and guides. To this date, most reports on the feasibility of this model refer to stable preterm infants admitted to Neonatal Intensive Care Units (NICUs). Objectives: To scale up and adapt FICare to make it suitable in level IIIC NICUs, which care for extreme prematurity and other complex medical or surgical neonatal conditions. Materials and Methods: Step 1 was the creation of the FICare implementation team (FICare-IT) and baseline analysis of current procedures for critical care to identify needs, wishes, and requirements; we aimed for protocol elaboration tailored to our cultural, architectural, and clinical context (March 2017 to April 2018). Step 2 as a dissemination strategy by FICare-IT acting as primary trainers and mentors to ensure the education of 90% of nursing staff (May 2018 to July 2018). Step 3 involved piloting and evaluation with the aim to refine the procedure (July 2018 to December 2020). Results: A rigorous but flexible protocol was edited. The FICare educational manual included two curricula: for healthcare professionals/staff (Training the trainers) and for families (Education of caregivers), the latter being categorized in two intervention levels (basic and advanced), depending on the infant care needs and parent's decision. In total, 76 families and 91 infants (74.7% preterm; 18.7% complex surgery; 6.6% others) were enrolled in the pilot. No differences in acceptance rate (overall 86.4%) or in the number of infant-family dyads in the program per month were observed when considering the pre- and post-Covid-19 pandemic periods. All families, except for one who dropped out of the program, completed the agreed individualized training. Mothers spent more time in NICU than fathers (p < 0.05); uninterrupted time spent by mothers in NICU was longer during the pre-pandemic period (p < 0.01). Observed time to reach proficiency by task was within the expected time in 70% of the program contents. The parents revealed educational manuals, workshops, and cot-side teaching sessions as essential for their training, and 100% said they would accept entry into the FICare program again. Conclusions: The principles of the FICare model are suitable for all levels of care in NICUs. Leadership and continuous evaluation/refinement of implementation procedures are essential components to achieve the objectives.
Collapse
Affiliation(s)
- Bárbara Moreno-Sanz
- Department of Neonatology, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research-IdIPAZ, La Paz University Hospital, Madrid, Spain
| | - María Teresa Montes
- Department of Neonatology, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research-IdIPAZ, La Paz University Hospital, Madrid, Spain
| | - Marta Antón
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | | | - Marta Cabrera
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research-IdIPAZ, La Paz University Hospital, Madrid, Spain
| |
Collapse
|
16
|
Xiang X, Xia S, Zhu X, Gao X, Gao X, Zhang A, Lee SK, Hei M. Attitudes and concerns of neonatologists and nurses to family-integrated-care in neonatal intensive care units in China. Transl Pediatr 2020; 9:603-609. [PMID: 33209722 PMCID: PMC7658773 DOI: 10.21037/tp-20-60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Parents in China are denied visitation of their newborns in neonatal intensive care unit (NICU), leading to a prolonged period of parent-infant separation. The family-integrated care (FICare) model, which supports the integration of parents into the NICU team, is gradually being introduced in China. Considering resistance to the implementation of FICare, this study aimed to assess the attitudes and concerns of neonatologists and nurses towards FICare in China. METHODS Using a before and after study design, a qualitative analysis was conducted to determine the perceptions and attitudes of medical professionals towards FICare in China. A total of 34 neonatologists and 94 nurses from 5 tertiary NICUs in China were enrolled. A self-developed questionnaire was used. The study steps included reading session and then survey for the first time (survey 1), a FICare getting buy-in education session (4 hours), a group discussion session, and finally repeat the questionnaire (survey 2). The surveys were completed by trained researchers regarding willingness, acceptance and concerns of implementing FICare in NICUs in China. Differences in attitudes towards FICare were compared between groups (Chi-square/correction for continuity). RESULTS There are positive responses in neonatologists and nurses regarding the necessity (Survey 1: 58.8% and 57.4%; Survey 2: 88.2% and 67.0%), feasibility (Survey 1: 17.6% and 19.1%; Survey 2: 32.3% and 34.0%), and interest in joining FICare (Survey 1: 82.4% and 83.0%; Survey 2: 97.1% and 85.1%). A higher proportion of neonatologists indicated that FICare could promote breastfeeding in the NICU comparing to nurses (Survey 1: 47.1% vs. 19.1%; Survey 2: 61.8% and 46.8% respectively). Most of the neonatologists and nurses are not sure whether FICare can shorten the hospital stay (Survey 1: 82.3% and 68.1%; Survey 2: 85.3% and 60.6%) or improve the doctor-patient relationship (Survey 1: 58.8% and 68.1%; Survey 2: 73.5% and 69.1%). Challenges concerning the implementation of FICare were identified as inadequate ward space, lack of human resources, and potential increases in nosocomial infection. CONCLUSIONS The getting buy-in education program in introducing new paradigms of neonatal care may help on how to design and implement more effective educational tools for FICare.
Collapse
Affiliation(s)
- Xiying Xiang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,National Center for Child Health, Beijing, China
| | - Shiwen Xia
- Department of Neonatology, Hubei Province Women and Children Hospital, Wuhan, China
| | - Xing Zhu
- Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiangyu Gao
- Department of Pediatrics, Southeast University Affiliated Xuzhou Hospital, Xuzhou, China
| | - Xirong Gao
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
| | - Aiming Zhang
- Department of Pediatrics, Hunan Provincial People's Hospital, Changsha, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,National Center for Child Health, Beijing, China
| |
Collapse
|
17
|
Hua W, Yuwen W, Simoni JM, Yan J, Jiang L. Parental readiness for hospital discharge as a mediator between quality of discharge teaching and parental self-efficacy in parents of preterm infants. J Clin Nurs 2020; 29:3754-3763. [PMID: 32644290 DOI: 10.1111/jocn.15405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the extent to which parental readiness for hospital discharge mediates the relationship between quality of discharge teaching and parental self-efficacy in parents of preterm infants. BACKGROUND Parental readiness for hospital discharge and self-efficacy should be considered to establish whether preterm infants and their families are prepared for the discharge. High-quality discharge teaching could facilitate a smooth discharge transition. However, little is known about how quality of discharge teaching influences parental readiness for hospital discharge and self-efficacy. DESIGN This was a descriptive cross-sectional study of 202 parents with preterm infants in a tertiary hospital in Eastern China. METHODS The key variables of interest were measured using the Chinese versions of the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale-Parent Form, and Preterm Parenting and Self-Efficacy Checklist. Path analyses were conducted to test the mediation models. STROBE checklist was used to compile the study's report. RESULTS Parental readiness for discharge (overall and knowledge dimension) partially mediated the relationship between the quality of discharge teaching and parental self-efficacy. The two dimensions (content received and delivery) of quality of discharge teaching positively influenced parental self-efficacy by improving parental readiness for discharge. CONCLUSIONS Parental readiness for hospital discharge, especially the knowledge dimension, was an important factor in quality of discharge teaching's association with self-efficacy in parents of preterm infants. Improving the quality of discharge teaching could increase parental readiness for discharge and thus promote parental self-efficacy. RELEVANCE TO CLINICAL PRACTICE Improving discharge instructions is essential to help parents of preterm infants prepare for the transition to home care. Assessing readiness and confidence at an early stage and continuing to do so throughout the hospital stay may provide additional ways for nurses to identify parents' knowledge gaps and to provide tailored interventions at more opportune times before hospital discharge.
Collapse
Affiliation(s)
- Wenzhe Hua
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Weichao Yuwen
- Nursing and Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Jie Yan
- Neonatology Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Chief Nursing Officer, Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
18
|
Comparison of family centered care with family integrated care and mobile technology (mFICare) on preterm infant and family outcomes: a multi-site quasi-experimental clinical trial protocol. BMC Pediatr 2019; 19:469. [PMID: 31791285 PMCID: PMC6886221 DOI: 10.1186/s12887-019-1838-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background Family Centered Care (FCC) has been widely adopted as the framework for caring for infants in the Neonatal Intensive Care Unit (NICU) but it is not uniformly defined or practiced, making it difficult to determine impact. Previous studies have shown that implementing the Family Integrated Care (FICare) intervention program for preterm infants in the NICU setting leads to significant improvements in infant and family outcomes. Further research is warranted to determine feasibility, acceptability and differential impact of FICare in the US context. The addition of a mobile application (app) may be effective in providing supplemental support for parent participation in the FICare program and provide detailed data on program component uptake and outcomes. Methods This exploratory multi-site quasi-experimental study will compare usual FCC with mobile enhanced FICare (mFICare) on growth and clinical outcomes of preterm infants born at or before 33 weeks gestational age, as well as the stress, competence and self-efficacy of their parents. The feasibility and acceptability of using mobile technology to gather data about parent involvement in the care of preterm infants receiving FCC or mFICare as well as of the mFICare intervention will be evaluated (Aim 1). The effect sizes for infant growth (primary outcome) and for secondary infant and parent outcomes at NICU discharge and three months after discharge will be estimated (Aim 2). Discussion This study will provide new data about the implementation of FICare in the US context within various hospital settings and identify important barriers, facilitators and key processes that may contribute to the effectiveness of FICare. It will also offer insights to clinicians on the feasibility of a new mobile application to support parent-focused research and promote integration of parents into the NICU care team in US hospital settings. Trial registration ClinicalTrials.gov, ID NCT03418870. Retrospectively registered on December 18, 2017.
Collapse
|
19
|
Abstract
BACKGROUND: Preterm mother-infant dyads often face many obstacles to breastfeeding. Preterm infants are at highest risk for low rates of exclusive breastfeeding. RESEARCH AIM: To determine the prevalence of breastfeeding at 6 months among preterm infants and to identify factors that influenced mothers' breastfeeding practices. METHODS: A longitudinal observational study was conducted in a metropolitan hospital in Beijing, China. Mothers ( N = 270) and their preterm infants ( N = 280) were included in the study. Characteristics of preterm mothers and their perceptions of breastfeeding self-efficacy, knowledge, social support, and postpartum depression symptoms were measured at the discharge of neonatal intensive care. Breastfeeding data were collected by phone interview at 6 months corrected age. RESULTS: At discharge, mothers of very preterm infants perceived a lower level of breastfeeding self-efficacy (measured with the Breastfeeding Self-Efficacy Scale-Short Form) and had a higher level of depression symptoms (measured with the Edinburgh Postnatal Depression Scale [EPDS]) than mothers of moderate and late preterm infants ( p < .05-.01). Nearly half of all mothers had an elevated EPDS score, considered to be symptomatic of postpartum depression. At 6 months, only 22.5% of all infants were exclusively breastfeeding. Factors associated with exclusive breastfeeding, including younger maternal age, previous breastfeeding experience, shorter mother-infant separation time during intensive care, older infant gestational age, and a higher level of breastfeeding self-efficacy, significantly predicted exclusive breastfeeding practice ( p < .05-.001). CONCLUSION: The prevalence of breastfeeding at 6 months for preterm infants in this sample was low. Strategies to improve breastfeeding duration for preterm infants are needed, including support and education of mothers while in the hospital.
Collapse
Affiliation(s)
- Ying Wang
- 1 Department of Neonatal Intensive Care Unit, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | | | - Wanli Xu
- 3 School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Xiaomei Cong
- 3 School of Nursing, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
20
|
Ding X, Zhu L, Zhang R, Wang L, Wang TT, Latour JM. Effects of family-centred care interventions on preterm infants and parents in neonatal intensive care units: A systematic review and meta-analysis of randomised controlled trials. Aust Crit Care 2019; 32:63-75. [PMID: 30554939 DOI: 10.1016/j.aucc.2018.10.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/27/2018] [Accepted: 10/28/2018] [Indexed: 01/30/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Xiang Ding
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Lihui Zhu
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Rong Zhang
- Neonatal Intensive Care Unit, Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Li Wang
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Ting-Ting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, People's Republic of China.
| | - Jos M Latour
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China; School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK.
| |
Collapse
|
21
|
Liu TT, Lei MJ, Li YF, Liu YQ, Meng LN, Jin CD. Effects of parental involvement in infant care in neonatal intensive care units: a meta-analysis. FRONTIERS OF NURSING 2018. [DOI: 10.1515/fon-2018-0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
This meta-analysis aimed to examine the effects of parental involvement in infant care in neonatal intensive care units (NICUs).
Methods
PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched till November 2017. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) examining the effect of parental involvement in the NICU were considered for inclusion.
Results
We included 10 studies (three RCTs, seven CCTs) with a total of 1,851 participants. The meta-analysis demonstrated that there were no statistically significant differences on nosocomial infection between two groups (risk ratio [RR] = 0.90, 95% CI 0.63–1.30, P = 0.58). Compared with no parental involvement groups, parental involvement groups showed more weight gain (mean difference [MD] = 1.47, 95% CI 0.65–2.29, P < 0.05), higher breast-feeding rate (RR = 1.38, 95% C11.25–1.53, P < 0.05), lower readmission rate (RR = 0.35, 95% CI 0.15–0.80, P < 0.05), and higher satisfaction rate (RR = 1.09, 95% CI 1.02–1.16, P< 0.05).
Conclusions
Parental involvement in the NICU interventions could not increase the rate of nosocomial infection of neonates, but could improve their weight gain, breast-feeding and parental satisfaction and decrease their readmission. However, since the conclusion of this meta-analysis was drawn based on the limited number of high-quality RCTs, more high-quality studies should be conducted in the future to confirm its positive intervention effects.
Collapse
Affiliation(s)
- Ting-Ting Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine , Tianjin 300193 , Tianjin China
| | - Meng-Jie Lei
- School of Nursing, Tianjin University of Traditional Chinese Medicine , Tianjin 300193 , Tianjin China
| | - Yu-Feng Li
- School of Nursing, Tianjin University of Traditional Chinese Medicine , Tianjin 300193 , Tianjin China
| | - Ya-Qian Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine , Tianjin 300193 , Tianjin China
| | - Li-Na Meng
- School of Nursing, Tianjin University of Traditional Chinese Medicine , Tianjin 300193 , Tianjin China
| | - Chang-De Jin
- School of Nursing, Tianjin University of Traditional Chinese Medicine , Tianjin 300193 , Tianjin China
| |
Collapse
|
22
|
He SW, Xiong YE, Zhu LH, Lv B, Gao XR, Xiong H, Wang H, Shi HR, Latour JM. Impact of family integrated care on infants' clinical outcomes in two children's hospitals in China: a pre-post intervention study. Ital J Pediatr 2018; 44:65. [PMID: 29871689 PMCID: PMC5989344 DOI: 10.1186/s13052-018-0506-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/28/2018] [Indexed: 12/29/2022] Open
Abstract
Background Most Neonatal Intensive Care Units (NICUs) in China have restricted visiting policies for parents. This also implicates that parents are not involved in the care of their infant. Family Integrated Care (FIC), empowering parents in direct care delivery and decisions, is becoming the standard in NICUs in many countries and can improve quality-of-life and health outcomes of preterm infants. The aim of this study was to evaluate the impact of a FIC intervention on the clinical outcomes of preterm infants with Bronchopulmonary Dysplasia (BPD). Methods A pre-post intervention study was conducted at NICUs in two Chinese children’s hospitals. Infants with BPD were included: pre-intervention group (n = 134) from December 2015 to September 2016, post-intervention (FIC) group (n = 115) and their parents from October 2016 to June 2017. NICU nurses were trained between July and September 2016 to deliver the FIC intervention, including parent education and support. Parents had to be present and care for their infant minimal three hours a day. The infants’ outcome measures were length-of-stay, breastfeeding, weight gain, respiratory and oxygen support, and parent hospital expenses. Results Compared with control group (n = 134), the FIC group (n = 115) had significantly increased breastfeeding rates (83% versus 71%, p = 0.030), breastfeeding time (31 days versus 19 days, p < 0.001), enteral nutrition time (50 days versus 34 days, p < 0.001), weight gain (29 g/day versus 23 g/day, p = 0.002), and significantly lower respiratory support time (16 days versus 25 days, p < 0.001). Oxygen Exposure Time decreased but not significant (39 days versus 41 days p = 0.393). Parents hospital expenses in local Chinese RMB currency was not significant (84 K versus 88 K, p = 0.391). Conclusion The results of our study suggests that FIC is feasible in two Chinese NICUs and might improve clinical outcomes of preterm infants with BPD. Further research is needed to include all infants admitted to NICUs and should include parent reported outcome measures. Our study may help other NICUs with limited parental access to implement FIC to enhance parental empowerment and involvement in the care of their infant.
Collapse
Affiliation(s)
- Shi-Wen He
- Nursing Department, Hunan Children's Hospital, Ziyuan Rd, Changsha, 410007 Hunan Province, China.,Hunan University of Traditional Chinese Medicine, Xueshi Rd, Changsha, Hunan, China
| | - Yue-E Xiong
- Division of Neonatal Medicine, Hunan Children's Hospital, Ziyuan Rd, Changsha, 41007 Hunan Province, China
| | - Li-Hui Zhu
- Nursing Department, Hunan Children's Hospital, Ziyuan Rd, Changsha, 410007 Hunan Province, China.
| | - Bo Lv
- Division of Neonatal Medicine, Hunan Children's Hospital, Ziyuan Rd, Changsha, 41007 Hunan Province, China
| | - Xi-Rong Gao
- Division of Neonatal Medicine, Hunan Children's Hospital, Ziyuan Rd, Changsha, 41007 Hunan Province, China
| | - Hua Xiong
- Nursing Department, Hunan Children's Hospital, Ziyuan Rd, Changsha, 410007 Hunan Province, China
| | - Huan Wang
- Nursing Department, Maternal and Child Health Hospital of Guiyang Province, Ruijinnan Rd, Guiyang, Guizhou, China
| | - Hua-Rong Shi
- Nursing Department, Maternal and Child Health Hospital of Guiyang Province, Ruijinnan Rd, Guiyang, Guizhou, China
| | - Jos M Latour
- Nursing Department, Hunan Children's Hospital, Ziyuan Rd, Changsha, 410007 Hunan Province, China.,School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| |
Collapse
|
23
|
Banerjee J, Aloysius A, Platonos K, Deierl A. Family centred care and family delivered care – What are we talking about? ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jnn.2017.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
Family Integrated Care (FICare) in Level II Neonatal Intensive Care Units: study protocol for a cluster randomized controlled trial. Trials 2017; 18:467. [PMID: 29017578 PMCID: PMC5634877 DOI: 10.1186/s13063-017-2181-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 09/08/2017] [Indexed: 01/22/2023] Open
Abstract
Background Every year, about 15 million of the world’s infants are born preterm (before 37 weeks gestation). In Alberta, the preterm birth rate was 8.7% in 2015, the second highest among Canadian provinces. Approximately 20% of preterm infants are born before 32 weeks gestation (early preterm), and require care in a Level III neonatal intensive care unit (NICU); 80% are born moderate (32 weeks and zero days [320/7] to 336/7 weeks) and late preterm (340/7 to 366/7 weeks), and require care in a Level II NICU. Preterm birth and experiences in the NICU disrupt early parent-infant relationships and induce parental psychosocial distress. Family Integrated Care (FICare) shows promise as a model of care in Level III NICUs. The purpose of this study is to evaluate length of stay, infant and maternal clinical outcomes, and costs following adaptation and implementation of FICare in Level II NICUs. Methods We will conduct a pragmatic, cluster randomized controlled trial (cRCT) in ten Alberta Level II NICUs allocated to one of two groups: FICare or standard care. The FICare Alberta model involves three theoretically-based, standardized components: information sharing, parenting education, and family support. Our sample size of 181 mother-infant dyads per group is based on the primary outcome of NICU length of stay, 80% participation, and 80% retention at follow-up. Secondary outcomes (e.g., infant clinical outcomes and maternal psychosocial distress) will be assessed shortly after admission to NICU, at discharge and 2 months corrected age. We will conduct economic analysis from two perspectives: the public healthcare payer and society. To understand the utility, acceptability, and impact of FICare, qualitative interviews will be conducted with a subset of mothers at the 2-month follow-up, and with hospital administrators and healthcare providers near the end of the study. Discussion Results of this pragmatic cRCT of FICare in Alberta Level II NICUs will inform policy decisions by providing evidence about the clinical effectiveness and costs of FICare. Trial registration ClinicalTrials.gov, ID: NCT02879799. Registered on 27 May 2016. Protocol version: 9 June 2016; version 2. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2181-3) contains supplementary material, which is available to authorized users.
Collapse
|