[Parent support activities in neonatal intensive care units: a national survey in Israel].

BACKGROUND: Parents of infants in Neonatal Intensive Care Units (NICU) suffer extended periods of stress. The staffs of these departments have a major role in assisting them through this period. AIM: To describe services, programs and facilities to support parents of these infants, during and following hospitalization. METHODS: Social workers of 23 NICU's completed a structured questionnaire, and the responses were summarized. RESULTS: The majority of units have paramedical staff in addition to social workers. Twenty-two units offer structured instruction for parents, and 12 offer lecture series. Topics include: coping with the birth of a premature infant, the infant's development and care, breastfeeding, discharge preparation, etc. In 19 departments grandparents are allowed to visit and nine also allow siblings. Most departments have breast-pump facilities and a lounge for parents; some also have refrigerators, personal lockers, etc.. Twenty units employ the "Kangaroo" method of skin-to-skin contact, and three practice elements of "individualized developmental care". Communication with parents is conducted both formally and informally. All departments have guidelines for contact with community health providers - some regularly, and some as-needed. CONCLUSION: Despite the multiplicity of programs reported in the survey, many are conducted in only a few departments. It is recommended that national guidelines be developed, which would integrate many existing activities, taking into account the needs of parents and families, medical and paramedical staff, as well as economic constraints. Clear policy guidelines and standards are necessary for this aspect of care, as they are for the medical aspects.

Postdischarge infant mortality among very low birth weight infants: a population-based study.

OBJECTIVE: The objective of this study was to identify factors that were associated with death after discharge from the NICU of very low birth weight infants in a population-based study. METHODS: From a national cohort of 13,430 very low birth weight infants who were born in Israel from 1995 to 2003, 10,602 infants were discharged from the hospital and composed the study population. Demographic and clinical data regarding the pregnancy, delivery, and neonatal course were obtained from the Israel national very low birth weight infant database. Data on each case of death during the postdischarge period until 1 year of age were provided by the Ministry of Health from national linked birth and death certificates. Univariate analyses and a multivariable logistic regression analyses were performed to examine the perinatal and neonatal risk factors for postdischarge death. RESULTS: The postdischarge mortality rate was 7.5 per 1000 (80 of 10,602 infants discharged from the hospital). The death rate was significantly higher in non-Jewish infants, infants who were born to young mothers, and infants who were born to low-educated mothers. After adjustment for demographic characteristics and perinatal and neonatal variables, postdischarge mortality was independently associated with congenital malformations, neonatal seizures, necrotizing enterocolitis, and bronchopulmonary dysplasia. CONCLUSION: Although the postdischarge death rate was relatively low in our cohort of very low birth weight infants, attention should be focused on the subgroups of infants who are at higher risk to decrease their mortality further.