Neonatal units have changed over the last decades, influenced by evidence emerging initially from low resource settings. In such countries, a lack of trained healthcare professionals has resulted in bringing the mothers to the cot side and supporting them to look after their infants. This has led to reduced mortality (1, 2), mortality from neonatal infections(3), less use of antibiotics, better breast-feeding rates(2), improved weight gain(2) earlier discharge home(2, 4) and reduced re-admission rates(4, 5). A pilot study from Tallinn, Estonia showed these improved infant outcomes as reduced neonatal infection, improved weight gain and breast-feeding rates (6). These studies also reported better parent experience, confidence and reduced anxiety(5).
While the western world, with its technological advances, was pushing the parents further away from their infants, the lack of provision of highly sophisticated medical care and lack of trained healthcare professionals, was bringing the parents and infants closer in the neonatal units of the East. During the latter half of 1980’s there was a realisation in the West that for better neurodevelopmental outcomes, early interventions, a humane approach was necessary. This has led to the development of structured programmes such as Neonatal Individualised Development Care Programme (NIDCAP)(7), Mother Infant transaction (MITP) programme (8) and Creating Opportunities for Parent Empowerment (COPE) programme(9). The main concept of these programmes is to support parents either by educational interventions or care-by-parents model or professional focussed support of the infant, with a developmental care programme.
The Family Integrated Care (FIC) programme piloted in Mt Sinai hospital in Toronto, Canada was co-designed by a multidisciplinary steering committee that included veteran parents, physicians, nurses, a parent educator, lactation consultant and a social worker. The pilot study reported it to be safe, feasible and resulted in improved weight gain among preterm infants. The subsequent RCT has also shown improved weight gain and breast-feeding rate, as well as reduced parental stress and anxiety (10). Recent results from the UK demonstrate similar findings(11) FIC programmes are feasible, do not come with additional costs, tare parent focussed and improve infant and parental outcomes; the principle of care is directed towards parents taking the ownership of their infants which imparts confidence and independence to the families, resulting in better long-term outcomes in their preterm infants.
However, the neonatal environment can present barriers to parental involvement; restricted access, nowhere for them to sit, sleep, eat or get the emotional support they need. Nursing education and communication skills can help the shift from nurses as doers to enablers; providing parent education to enable parents to be involved as partners in their baby’s care. With support, parents can be encouraged to get to know and interact with their baby, read their cues and respond to their needs for comfort, feel confident to touch and hold their baby in skin to skin and do their care; nappy changes, cleaning, taking temperature, mouthcare and feeding. Parents know their baby best and can be active participants in ward rounds, presenting their baby to the team and being involved in the decision making.
Furthermore, although Neonatal care has advanced and improved the outcomes for babies in its care, the focus has been predominately on reducing mortality and morbidities for babies during their neonatal stay and their physical health outcomes post discharge. Less focus is concentrated on the outcomes for parents and the early relationships built with their baby.
There is now more attention being paid to the potential consequent outcomes for parental mental health and wellbeing and resultant longer term outcomes and impact on families.
Recent research and interventions have focused on the importance of developing a close and loving relationship by involving parents in their babies care right from the beginning. Evidence suggests that what happens in the first hours and days of a family’s experience of neonatal care can have a significant impact on outcome.
Antenatal care, communication and information given in preparation for delivery and birth, delivery room opportunities for closeness and expressing colostrum, early opportunities to get to know their baby and be actively involved in their care can get the neonatal journey off to the best possible start, improve their neonatal experience and create better longer term outcomes for family. Breastmilk and breastfeeding supports optimal outcomes in neonatal care; it is easy to digest, reduces the incidence of necrotising enterocolitis (NEC), Retinopathy of prematurity (ROP), Bronchopulmonary dysplasia (BPD), infections including late onset sepsis and improves neurodevelopmental outcome, but there can be challenges in neonatal care in getting it off to the best start.
Author:
Included in a long list of credentials, Annie Aloysius MRCSLT IBCLC sits on the editorial board of the Journal of Neonatal Nursing, is chair of the RCSLT Neonatal Clinical Excellence Network and has published a number of chapters and articles in her specialist clinical area. Annie helped devise Best Beginnings’ Small Wonders Change Programme – a series of mini documentaries to inform and empower parent of premature and sick babies
References:
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