Professionals Evidence, impact & evaluation Small Wonders – the evidence base The Small Wonders Change Programme is aimed at supporting healthcare staff to enable families to be at the heart of their babies care in ways that are known to improve health outcomes of the child and the wellbeing of the family. Prevalence of premature and sick babies One in 13 babies in the UK are born prematurely, that is below 37 weeks gestation, and many are born extremely prematurely at gestational ages as low as 22 weeks. In the UK this amounts to 80,000 premature births every year. Socio-economic disadvantage and its association with premature birth and sickness in infancy Families who are less socioeconomically advantaged are more likely to have babies who need to be admitted to a neonatal unit* (2009) (2005) for a variety of reasons, and are more likely to have babies that are smaller than the average weight at gestation. Moreover, preterm babies born to the least socioeconomically advantaged families are also less likely to survive; preterm babies born to families in deprived areas are more than twice as likely not to survive as those premature babies born to families in least deprived areas (2009).Young mothers are also more likely to give birth prematurely; mothers under the age of 18 are 21% more likely to have a premature baby with their first pregnancy and 93% more likely to have a premature baby with their second pregnancy compared with mothers aged 20-29 (2010). Family-Centered Care When a baby is born premature or sick, they are cared for on a neonatal unit, frequently this means that the baby is physically separated from the mother and the rest of the family because they are in an incubator. There is evidence that maximizing possibilities for parents to be involved in caring for their baby at this critical time can improve infant bonding and health outcomes. Best Practice Based on evidence, national government guidelines recommend making care of premature and sick babies more family centred; the toolkit for high quality neonatal services (2009) recommends that ‘Parents are encouraged and supported to participate in their baby’s care at the earliest opportunity, including: regular skin-to-skin care providing comforting touch and comfort holding, particularly during painful procedures feeding day-to-day care such as nappy changing This also recommends that: all parents are introduced to facilities, routines, staff and equipment on admission to a neonatal unit. written information is available to all users of the service to permit early and effective communication with parents. Breast milk for premature and sick babies One of the key things that mothers can do at this time is to produce breast milk for the baby. Breast milk is particularly important for premature and sick babies, because it: reduces infections (2003) and necrotizing enterocolitis (1990) which are common cause of mortality advances their mental and emotional development (2007) reduces their experience of pain during painful procedures (2006) However, the number of sick and premature babies who receive breast milk varies greatly across the UK; the number of babies on neonatal units being fed either partially or wholly on breast milk when they are discharged varies from as low as 1% to a high as 77% (2010). Kangaroo Care A mother having skin-to-skin contact with a premature or sick baby (holding the baby directly on her chest), also known as ‘Kangaroo Care’ is associated with her being more likely to produce breast milk (1997). In addition a women having Kangaroo Mother Care (early, continuous and prolonged skin-to-skin contact between the mother and the baby) is also known to be associated with improved bonding (1998) and has a number of other positive health outcomes, including: reducing the baby’s susceptibility to infection (2011) reduced mortality (2011) helping stabilise the baby’s temperature (2011) reduced hospital stay (2011) improved mother infant interaction: improvement in mother’s sensitivity, infant responsiveness and perceptions of social support and decrease in mothers’ feelings of worry and stress (2011) better cognitive development and brain maturation (2003) and (2003) Despite this clear evidence of benefit, parents who took part in the Picker Institute National Survey of Parent Experience of Neonatal Care (2011) who said they had definitely had as much Kangaroo Care with their baby as they wanted ranged from as low as 22% to as high as 79% across units and overall 1 in 10 parents did not know about Kangaroo Care. Amongst the youngest age group of parents (16-27) only 44% said they had ‘definitely’ had as much Kangaroo Care with their baby as they had wanted. Read about the Kangaroo Care Sticker project. Parent experience However, the extent to which families are routinely informed about and properly supported to be involved in their baby’s care is varied:The Picker Institute National Survey of parent experience of neonatal care (2011) showed: preparation for birth: the number of parents who said a member of staff from the neonatal unit talked to them about what to expect after birth ranged from as low as 17% to as high as 76%. involving parents in their baby’s cares: the number of parents who said staff arranged their baby’s care around their visits ranged from 34 to 92%. information: almost half of parents (43%) said they were not given enough information or only given information ‘to some extent’ about the neonatal unit. 44% of parents said that staff ‘sometimes’ or ‘often’ gave them conflicting information. support: 42% of parents reported they were not given enough support overall or only got enough support ‘to some extent’. preparation for discharge: the number of parents who said they ‘definitely felt ready for discharge’ ranged from 57% to 95%. The contrast between recommended practice and the varied reality is stark and may be due to a number of reasons, including lack of staff training, which can be a barrier to implementing effective interventions (2009).