The effect of family integrated care on the prognosis of premature infants

According to the relevant data, the incidence of preterm birth in China is 4%-7%, and the trend is increasing year by year [1, 2]. Because preterm infants are less adaptable to the outside world and have weaker resistance, they are more susceptible to harmful factors. Therefore, preterm infants generally need to be cared for in hospital neonatal intensive care units (NICU) after birth [3]. In the NICU, infants are physically separated from their parents, which often has an impact on the physical, mental and emotional health of both parents and infants. Family-centered care is an approach to planning and delivering health services that encourages more parental involvement in the care of the infant. However, in the NICU, parents usually play only a supportive role and the majority of the infant's care is provided by NICU professionals [4]. Therefore, how to effectively establish a neonatal intensive care unit, maintain parent–child relationships for parents of preterm infants, develop parental caregiving skills, and increase breastfeeding rates are pressing issues for healthcare professionals to address. The Family Integrated Care (FICare) is a model that is an extension of the principles of family-centered care. It is a model through which parents are true partners in the care of their infants, even in the NICU. In FICare, the inclusion of parents on the care team goes far beyond just allowing parents to be present and observe their infant's care [5‐7]. FIcare in single family rooms has been reported to decrease the incidence of late-onset sepsis in preterm infants and shorter length of their hospital stay [8]. A randomized controlled trial of infants in Alberta confirmed that FIcare is effective in reducing the length of hospital stay of preterm infants [9]. Yet, fewer domestic reports have been published on the application of the FICare in preterm infants in China. On this basis, we investigated the effect of FICare on the prognosis of children hospitalized with preterm infants and parental outcomes in this study.

Premature infants often require lengthy hospital stays in NICU due to immature organ functioning that require them to establish respiratory stability and learn how to eat by mouth. During hospitalization they can also experience complications such as sepsis due to impaired immunological functioning [12, 13].The closed NICU can cause separation of mother and infant, resulting in difficulties for mothers to adapt to their new role, and even though nursing staff provides adequate health promotion education to parents, parents still lack the ability to care for their preterm infants, often leading to readmission of preterm infants due to inadequate care [14]. In many countries, parents of preterm infants are allowed to enter the NICU, kangaroo cuddling and family-centered care (FCC), all of which can improve the prognosis of patients and promote the development of family bonding, enabling parents to establish their parental role early and acquire knowledge and skills in neonatal care [15, 16]. At present, China has just started to implement family-involvement integrated management, which allows parents to visit in the NICU, but the visiting time is < 4 h, which hinders the establishment of emotional communication and intimate relationship between parents and newborns. Therefore, when exploring the implementation of family-involvement integrated management, we also attempted FICare in China.

In the NICU, as in the FCC, although the parents are involved in the care process, they usually only play a supporting role. FICare differs from FCC in that the parents are involved in all the processes of touching, feeding and bathing, and are the most important members of the care team in FIC, far beyond the observation of the medical staff present to care for the baby.

The results of this study showed that the intervention group had shorter nasogastric tube retention time, total enteral nutrition time, exclusive breastfeeding rate, shorter hospital stay, and faster weight gain compared with the control group (P < 0.05), suggesting that the FICare is beneficial to improve the prognosis level of the children. This may be due to the fact that preterm infants are transferred to the neonatal intensive care unit at birth, which separates mother and infant, and mothers worry about the prognosis of preterm infants, which is often accompanied by various negative emotions and is not conducive to their own recovery and that of the infant; at the same time, negative emotions can affect lactation, and with the lack of knowledge of mothers, preterm infants do not receive adequate breastfeeding, and all of these reasons are not conducive to the recovery of preterm infants and mothers themselves [17]. However, through FICare, close contact between mother and child, such as through touch, can relieve the mother's postnatal anxiety, promote lactation and uterine recovery, and the mother's caressing and cuddling of the newborn can increase the excitability of the vagus nerve in preterm babies, increasing the efficiency of food digestion and absorption, facilitating the absorption of nutrients and shortening the time to full intestinal feeding [18].

Height, weight, and head circumference are the most volatile of the neonatal growth indicators and the most readily available indicators of neonatal physical growth, and are the most important indicators of neonatal physical growth and nutritional status. Height, weight, and head circumference, especially weight, are directly related to the long-term prognosis of preterm infants and are important predictors of health outcomes in preterm infants. In a study by OK Kara et al., it was found that neonatal-centered "family-based" care was more beneficial to the growth and development of preterm infants [19]. The study by X Ding et al. also confirmed that integrated family care improved the feeding status of preterm infants in the NICU and contributed to the growth and development of preterm infants [20]. The results of this study showed that the growth and development of the intervention group were better compared with the control group (P < 0.05), suggesting that the FICare is beneficial to the growth and development of children hospitalized with preterm infants. This may be due to the fact that the FICare can provide time and space for close mother-infant contact and parental embrace feeding, which is more conducive to breastfeeding, and breastfeeding helps the absorption of nutrients, thus contributing to the growth and development of hospitalized newborns.

Self-efficacy is a judgment or belief about one's ability to successfully organize and complete a relevant task [21]. Our study showed that after the intervention, parental self-efficacy was higher in the intervention group compared to the control group, suggesting that the FICare can increase the self-efficacy of parents of children hospitalized with preterm infants. In this study, the implementation of FICare prompted parents to come to the ward 24 h actively to participate in the care of preterm infants, which increased parents' understanding of the disease and mastery of the condition. It can also compensate for the lack of parental role, effectively establish parent–child relationship, increase parent–child affection, meet the physical and psychological needs of parents and preterm infants, and reduce negative emotions. In addition, family functioning is the role played by family members in accomplishing various aspects of family tasks, and its ability to measure the effectiveness of family functioning is an important marker [22]. The strengths and weaknesses of family functioning are closely related to the physical and mental health of family members, and conversely, the health of family members can affect family functioning. Therefore, the results of this study showed that after the intervention, family functioning was higher in the intervention group compared with the control group (P < 0.05), suggesting that the FICare can improve the family functioning of parents of children hospitalized with preterm infants, which can improve the intimacy and cooperation among family members, create a relaxing and pleasant environment for parents, and promote their physical and mental health.

There are some limitations in our study. Since the development and application of the FICare requires support from various aspects such as human management components and hardware facilities, our data are relatively limited and need to be expanded into an in-depth study with a larger sample size. In addition, our data are mainly from preterm infants in China, and it is uncertain whether newborns in other countries around the world would also benefit from the FICare, which is a question that needs to be further explored later.

In conclusion, the FICare can shorten the time to nasogastric tube placement, time to full enteral nutrition, exclusive breastfeeding rate, length of stay, increase weight gain rate, facilitate growth and development of preterm infants, improve parental self-efficacy and family functioning, reduce readmission rate, and not increase the incidence of infection and choking, and improve patient prognosis, which may be possible to promote the treatment of preterm children and bring benefits to parents.