Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands.
Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, the Netherlands.
JAMA Netw Open. 2022 Mar 1;5(3):e224514. doi: 10.1001/jamanetworkopen.2022.4514.
Active participation in care by parents and zero separation between parents and their newborns is highly recommended during infant hospitalization in the neonatal intensive care unit (NICU).
To study the association of a family integrated care (FICare) model with maternal mental health at hospital discharge of their preterm newborn compared with standard neonatal care (SNC).
DESIGN, SETTING, AND PARTICIPANTS: This prospective, multicenter cohort study included mothers with infants born preterm treated in level-2 neonatal units in the Netherlands (1 unit with single family rooms [the FICare model] and 2 control sites with standard care in open bay units) between May 2017 and January 2020 as part of the AMICA study (fAMily Integrated CAre in the neonatal ward). Participants included mothers of preterm newborns admitted to participating units. Data analysis was performed from January to April 2021.
FICare model in single family rooms with complete couplet-care for the mother-newborn dyad during maternity and/or neonatal care.
Maternal mental health, measured using the Parental Stress Scale: NICU (PSS-NICU). Secondary outcomes included survey scores on the Hospital Anxiety and Depression Scale, Postpartum Bonding Questionnaire, Perceived Maternal Parenting Self-efficacy Scale, and satisfaction with care (using EMPATHIC-N). Parent participation (using the CO-PARTNER tool) was assessed as a potential mediator of the association of the FICare model on outcomes with mediation analyses.
A total of 296 mothers were included; 124 of 141 mothers (87.9%) in the FICare model and 115 of 155 (74.2%) mothers in SNC responded to questionnaires (mean [SD] age: FICare, 33.3 [4.0] years; SNC, 33.3 [4.1] years). Mothers in the FICare model had lower total PSS-NICU stress scores at discharge (adjusted mean difference, -12.24; 95% CI, -18.44 to -6.04) than mothers in SNC, and specifically had lower scores for mother-newborn separation (adjusted mean difference, -1.273; 95% CI, -1.835 to -0.712). Mothers in the FICare model were present more (>8 hours per day: 105 of 125 [84.0%] mothers vs 42 of 115 [36.5%]; adjusted odds ratio, 19.35; 95% CI, 8.13 to 46.08) and participated more in neonatal care (mean [SD] score: 46.7 [6.9] vs 40.8 [6.7]; adjusted mean difference, 5.618; 95% CI, 3.705 to 7.532). Active parent participation was a significant mediator of the association between the FICare model and less maternal depression and anxiety (adjusted indirect effect, -0.133; 95% CI, -0.226 to -0.055), higher maternal self-efficacy (adjusted indirect effect, 1.855; 95% CI, 0.693 to 3.348), and better mother-newborn bonding (adjusted indirect effect, -0.169; 95% CI, -0.292 to -0.068).
The FICare model in our study was associated with less maternal stress at discharge; mothers were more present and participated more in the care for their newborn than in SNC, which was associated with improved maternal mental health outcomes. Future intervention strategies should aim at reducing mother-newborn separation and intensifying active parent participation in neonatal care.
Netherlands Trial Register identifier NL6175.
在新生儿重症监护病房（NICU）住院期间，强烈建议父母积极参与护理，并且父母和新生儿之间不能分离。
与标准新生儿护理（SNC）相比，研究家庭综合护理（FICare）模式与早产儿母亲出院时心理健康之间的关系。
设计、地点和参与者：这项前瞻性、多中心队列研究纳入了 2017 年 5 月至 2020 年 1 月期间在荷兰 2 级新生儿单位接受治疗的早产儿母亲（1 个单位采用单家庭病房[FICare 模式]，2 个对照单位采用开放式婴儿床单元的标准护理），作为 AMICA 研究（新生儿病房中家庭综合护理）的一部分。参与者包括接受参与单位治疗的早产儿母亲。数据分析于 2021 年 1 月至 4 月进行。
在产科和/或新生儿护理期间，母亲-新生儿对子实行完全对偶护理的单家庭病房中的 FICare 模式。
使用新生儿重症监护室父母压力量表（PSS-NICU）测量母亲心理健康。次要结果包括使用医院焦虑和抑郁量表、产后依恋问卷、感知母亲育儿自我效能感量表和护理满意度（使用 EMPATHIC-N）进行的调查评分。使用 CO-PARTNER 工具评估父母参与度作为 FICare 模式对结果的关联的潜在中介，并进行中介分析。
共纳入 296 名母亲，141 名母亲中有 124 名（87.9%）在 FICare 模式，155 名母亲中有 115 名（74.2%）在 SNC 中对问卷做出了回应（平均[标准差]年龄：FICare，33.3[4.0]岁；SNC，33.3[4.1]岁）。与 SNC 组相比，FICare 模式组的母亲在出院时的总 PSS-NICU 压力评分较低（调整后的平均差异，-12.24；95%CI，-18.44 至-6.04），特别是在母亲-新生儿分离方面的评分较低（调整后的平均差异，-1.273；95%CI，-1.835 至-0.712）。FICare 模式组的母亲在护理过程中存在的时间更长（每天>8 小时：125 名母亲中有 105 名[84.0%] vs 115 名母亲中有 42 名[36.5%]；调整后的优势比，19.35；95%CI，8.13 至 46.08），并且更多地参与新生儿护理（平均[标准差]评分：46.7[6.9] vs 40.8[6.7]；调整后的平均差异，5.618；95%CI，3.705 至 7.532）。积极的父母参与是 FICare 模式与母亲抑郁和焦虑程度较低（调整后的间接效应，-0.133；95%CI，-0.226 至-0.055）、母亲自我效能感较高（调整后的间接效应，1.855；95%CI，0.693 至 3.348）和更好的母婴依恋（调整后的间接效应，-0.169；95%CI，-0.292 至-0.068）之间关联的重要中介因素。
我们研究中的 FICare 模式与出院时母亲压力较低有关；母亲在护理新生儿方面的存在时间更长，参与度更高，而不是 SNC，这与改善母亲的心理健康结果有关。未来的干预策略应旨在减少母婴分离，并加强父母在新生儿护理中的积极参与。
荷兰试验登记处标识符 NL6175。
