A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit.

BACKGROUND: We have developed a Family Integrated Care (FIC) model for use in a neonatal intensive care unit (NICU) where parents provide most of the care for their infant, while nurses teach and counsel parents. The objective of this pilot prospective cohort analytic study was to explore the feasibility, safety, and potential outcomes of implementing this model in a Canadian NICU. METHODS: Infants born ≤ 35 weeks gestation, receiving continuous positive airway pressure or less respiratory support, with a primary caregiver willing and able to spend ≥ 8 hours a day with their infant were eligible. Families attended daily education sessions and were mentored at the bedside by nurses. The primary outcome was weight gain, as measured by change in z-score for weight 21 days after enrolment. For each enrolled infant, we identified two matched controls from the previous year's clinical database. Differences in weight gain between the two groups were analyzed using a linear mixed effects multivariable regression model. We also measured parental stress levels using the Parental Stress Survey: NICU, and interviewed parents and nurses regarding their experiences with FIC. RESULTS: This study included 42 mothers and their infants. Of the enrolled infants, matched control data were available for 31 who completed the study. The rate of change in weight gain was significantly higher in FIC infants compared with control infants (p < 0.05). There was also a significant increase in the incidence of breastfeeding at discharge (82.1 vs. 45.5%, p < 0.05). The mean Parental Stress Survey: NICU score for FIC mothers was 3.06 ± 0.12 at enrolment, which decreased significantly to 2.30 ± 0.13 at discharge (p < 0.05). Feedback from the parents and nurses indicated that FIC was feasible and appropriately implemented. CONCLUSIONS: This study suggests that the FIC model is feasible and safe in a Canadian healthcare setting and results in improved weight gain among preterm infants. In addition, this innovation has the potential to improve other short and long-term infant and family outcomes. A multi-centre randomized controlled trial is needed to further evaluate the efficacy of FIC in the Canadian context.

Clínica de Lactancia: experiencia de 2 años / Lactation Clinic: two years experience

La necesidad de apoyar la lactancia en la etapa crítica del egreso de la maternidad requiere de múltiples estrategias. Se presenta la experiencia de la Clínica de Lactancia que funciona dentro de la maternidad. Se trata de un análisis retrospectivo de los registros de los binomios que concurrieron a la clínica en el bienio 2005-2007. Se cita a las madres en las que se detectaron dificultades en el amamantamiento durante la estadía en el alojamiento conjunto, para las siguientes 48 horas luego del alta. Se monitoriza en esa instancia, la evolución de los problemas surgidos en el período posnatal inmediato, con abordaje sistematizado.Concurren a la clínica 19,5% del total de los binomios. Se analizan las dificultades surgidas luego del alta. Del total de las consultas el 56% de los recién nacidos continuaron con lactancia exclusiva con el apoyo brindado en la clínica. El 23% de los binomios asistidos requirieron nueva evolución. Los recién nacidos con lactancia exclusiva favorable inician curva de peso en ascenso luego del cuarto día de vida con incremento de peso promedio de 41 gramos por día.

Lactation support after Maternity discharge requires a lot of strategies. Our experience in Lactation Clinic is presented. A retrospective analysis about the patients evaluated between 2005-2007 is shown. Mothers with detected problems in achieving effective lactation were scheduled to come to the Maternity area 48 hours after the discharge .The evolution in the lactogenesis, and the effective suction was analyzed in a planified form. 56% of the scheduled new borns continued with exclusive lactation wether 23% needed new evaluation. New borns began gaining weight after the fourth day of life with an average increment of 41 g per day.