Nursing Department, Hunan Children's Hospital, Ziyuan Rd, Changsha, 410007 Hunan Province, China.
Hunan University of Traditional Chinese Medicine, Xueshi Rd, Changsha, Hunan, China.
Ital J Pediatr. 2018 Jun 5;44(1):65. doi: 10.1186/s13052-018-0506-9.
Most Neonatal Intensive Care Units (NICUs) in China have restricted visiting policies for parents. This also implicates that parents are not involved in the care of their infant. Family Integrated Care (FIC), empowering parents in direct care delivery and decisions, is becoming the standard in NICUs in many countries and can improve quality-of-life and health outcomes of preterm infants. The aim of this study was to evaluate the impact of a FIC intervention on the clinical outcomes of preterm infants with Bronchopulmonary Dysplasia (BPD).
A pre-post intervention study was conducted at NICUs in two Chinese children's hospitals. Infants with BPD were included: pre-intervention group (n = 134) from December 2015 to September 2016, post-intervention (FIC) group (n = 115) and their parents from October 2016 to June 2017. NICU nurses were trained between July and September 2016 to deliver the FIC intervention, including parent education and support. Parents had to be present and care for their infant minimal three hours a day. The infants' outcome measures were length-of-stay, breastfeeding, weight gain, respiratory and oxygen support, and parent hospital expenses.
Compared with control group (n = 134), the FIC group (n = 115) had significantly increased breastfeeding rates (83% versus 71%, p = 0.030), breastfeeding time (31 days versus 19 days, p < 0.001), enteral nutrition time (50 days versus 34 days, p < 0.001), weight gain (29 g/day versus 23 g/day, p = 0.002), and significantly lower respiratory support time (16 days versus 25 days, p < 0.001). Oxygen Exposure Time decreased but not significant (39 days versus 41 days p = 0.393). Parents hospital expenses in local Chinese RMB currency was not significant (84 K versus 88 K, p = 0.391).
The results of our study suggests that FIC is feasible in two Chinese NICUs and might improve clinical outcomes of preterm infants with BPD. Further research is needed to include all infants admitted to NICUs and should include parent reported outcome measures. Our study may help other NICUs with limited parental access to implement FIC to enhance parental empowerment and involvement in the care of their infant.
中国大多数新生儿重症监护病房（NICU）都对家长实行限制探视政策。这也意味着家长无法参与婴儿的护理。家庭综合护理（FIC）使父母能够直接参与护理和决策，正在成为许多国家 NICU 的标准，可改善早产儿的生活质量和健康结局。本研究旨在评估 FIC 干预对患有支气管肺发育不良（BPD）的早产儿临床结局的影响。
本研究采用前后对照干预研究，在两家中国儿童医院的 NICU 进行。纳入患有 BPD 的婴儿：2015 年 12 月至 2016 年 9 月的预干预组（n=134）、2016 年 10 月至 2017 年 6 月的干预组（FIC 组，n=115）及其父母。2016 年 7 月至 9 月，对 NICU 护士进行了培训，以实施 FIC 干预，包括家长教育和支持。要求家长每天至少在场并护理婴儿 3 小时。评估婴儿的转归指标包括住院时间、母乳喂养、体重增加、呼吸和吸氧支持以及家长住院费用。
与对照组（n=134）相比，FIC 组（n=115）的母乳喂养率显著升高（83% vs 71%，p=0.030），母乳喂养时间（31 天 vs 19 天，p<0.001）、肠内营养时间（50 天 vs 34 天，p<0.001）、体重增加（29 g/天 vs 23 g/天，p=0.002），以及呼吸支持时间显著缩短（16 天 vs 25 天，p<0.001）。吸氧时间虽有所减少，但无统计学意义（39 天 vs 41 天，p=0.393）。家长在当地人民币货币的住院费用无显著差异（84 千 vs 88 千，p=0.391）。
本研究结果表明，FIC 在中国两家 NICU 是可行的，可能改善患有 BPD 的早产儿的临床结局。需要进一步的研究，将所有入住 NICU 的婴儿纳入其中，并包括家长报告的结局指标。本研究可能有助于其他限制家长探视的 NICU 实施 FIC，以增强家长的权能并使其参与婴儿护理。
