Family Integrated Care in the NICU

Mount Sinai Hospital, Canada720 enrolled

Overview

In the highly technological environment of the modern neonatal intensive care unit (NICU), the infant is physically, psychologically and emotionally separated from its parents. Recognition that this impedes parent- infant interaction and is detrimental to the infant, led to the development of programs such as family centered care, kangaroo care and skin-to-skin care1-3. However, they are based on the common premise that only NICU professionals with special skills can provide care for the infant. Parents are relegated to a supportive role, and some have described themselves as voyeurs who are "allowed" to visit and hold their infants4. Many feel anxious and unprepared to care for their infants after discharge5. In 1979, a shortage of NICU nurses in Estonia prompted Levin1,6 to implement a "humane" care model in which parents provided nursing care for the infant (except for administration of IV fluid and medication), while nurses provided teaching and guidance to parents. This resulted in 30% improvement in weight gain1,30% reduction in infections, 20% reduction in NICU length of stay, 50% reduction in nurse utilization and overall improved satisfaction among parents and staff \[personal communication, Levin,A.\]. Building on the Estonian experience, we have developed a new Family Integrated Care (FIC) model that is adapted for the NICU environment in North America. In a pilot study at Mount Sinai Hospital, Toronto 46 infants and their families were enrolled in the study. Preliminary results and feedback from parents and healthcare providers (HCP) show that the FIC model is both feasible and safe, and may lead to improved outcomes including improved weight gain(paper submitted for publication). This study is a cluster randomized controlled trial in 16 tertiary level NICUs, to evaluate the efficacy of the FIC model in Canada.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Masking

NONE

Enrollment

720

Conditions

Eligibility

Sex: ALLMax age: 33 Weeks

Medical Language ↔ Plain English

Inclusion Criteria: * \< 33 weeks gestational age at birth; * On no respiratory support or low level respiratory support (i.e., oxygen by cannula or mask, or continuous positive airway pressure (CPAP); * A primary caregiver parent who is willing and able to commit to spending at least 8 hours per day with her/his infant between the hours of 0700 and 2000; * Parental consent. Exclusion Criteria: * Palliative care; * Major life threatening congenital anomaly; * Critical illness (unlikely to survive); * On high level of respiratory support (mechanical ventilator, high frequency oscillatory or jet ventilation, extra-corporeal membrane oxygenation) * Parental request for early transfer to another hospital; * Parental inability to participate (e.g., health, social or language issues that might inhibit their ability to communicate with the healthcare team).

Locations (15)

Foothills Medical Centre

Calgary, Alberta, Canada

Health Sciences Centre, Winnipeg

Winnipeg, Manitoba, Canada

St. Boniface General Hospital

Winnipeg, Manitoba, Canada

The Moncton Hospital

Moncton, New Brunswick, Canada

Saint John Regional Hospital

Saint John, New Brunswick, Canada

IWK Health Centre

Halifax, Nova Scotia, Canada

Hamilton Health Sciences Centre

Hamilton, Ontario, Canada

London Health Sciences Centre

London, Ontario, Canada

Hospital for Sick Children

Toronto, Ontario, Canada

Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

...and 5 more locations

Outcomes

Primary Outcomes

Weight Gain

Change in weight from enrollment to day 21 following commencement of the intervention

Time frame: Day 0-21

Secondary Outcomes

Weight gain velocity

Weight gain velocity at 21 days post-intervention commencement;

Time frame: Day 0-21

Breastfeeding rate

Participants will be followed until first discharge home from hospital, an expected average 13 weeks

Time frame: up to 16 weeks

Clinical outcomes (mortality and Nosocomial infection (NI), Necrotizing Enterocolitis (NEC), Bronchopulmonary Dysplasia(BPD), Retinopathy of prematurity(ROP) & Intraventricular haemorrhage(IVH)

Patients will be followed for the duration of their hospital stay for an expected average of 13 weeks. Mortality and five major morbidities: (a) Nosocomial infection will be defined using the Center for Disease Control criteria; (b) Necrotizing enterocolitis is defined using Bell's criteria;(c) Bronchopulmonary dysplasia is defined according to Shennan et al; (d) Intraventricular hemorrhage will be classified using the Canadian Pediatric Society classification, from cranial ultrasound performed during the first 28 days of life; (e) Retinopathy of prematurity will be staged according to the International Classification of Retinopathy of Prematurity.

Time frame: up to 16 weeks

Safety

Number of critical incident reports/1000 patient days

Time frame: 1000 patient days

Parental stress and anxiety

We will administer questionnaires to parents in the first week following admission and when their infant reaches 35 weeks corrected gestational age, in both the intervention and control sites

Time frame: Day 0 and when the infant reaches 35 weeks corrected gestational age

Resource Use

Data on health care utilisation will be collected during the patients entire hospital stay until the first discharge home, averaging 13 weeks including length of stay, duration of oxygen therapy. Per diem costs will be used to estimate potential cost savings derived from any reduced length of stay.

Time frame: Day 0 -week 16