Comparison of family centered care with family integrated care and mobile technology (mFICare) on preterm infant and family outcomes: a multi-site quasi-experimental clinical trial protocol.

BackgroundFamily Centered Care (FCC) has been widely adopted as the framework for caring for infants in the Neonatal Intensive Care Unit (NICU) but it is not uniformly defined or practiced, making it difficult to determine impact. Previous studies have shown that implementing the Family Integrated Care (FICare) intervention program for preterm infants in the NICU setting leads to significant improvements in infant and family outcomes. Further research is warranted to determine feasibility, acceptability and differential impact of FICare in the US context. The addition of a mobile application (app) may be effective in providing supplemental support for parent participation in the FICare program and provide detailed data on program component uptake and outcomes.MethodsThis exploratory multi-site quasi-experimental study will compare usual FCC with mobile enhanced FICare (mFICare) on growth and clinical outcomes of preterm infants born at or before 33 weeks gestational age, as well as the stress, competence and self-efficacy of their parents. The feasibility and acceptability of using mobile technology to gather data about parent involvement in the care of preterm infants receiving FCC or mFICare as well as of the mFICare intervention will be evaluated (Aim 1). The effect sizes for infant growth (primary outcome) and for secondary infant and parent outcomes at NICU discharge and three months after discharge will be estimated (Aim 2).DiscussionThis study will provide new data about the implementation of FICare in the US context within various hospital settings and identify important barriers, facilitators and key processes that may contribute to the effectiveness of FICare. It will also offer insights to clinicians on the feasibility of a new mobile application to support parent-focused research and promote integration of parents into the NICU care team in US hospital settings.Trial registrationClinicalTrials.gov, ID NCT03418870. Retrospectively registered on December 18, 2017

Supporting play exploration and early developmental intervention versus usual care to enhance development outcomes during the transition from the neonatal intensive care unit to home: a pilot randomized controlled trial

Background While therapy services may start in the Neonatal Intensive Care Unit (NICU) there is often a gap in therapy after discharge. Supporting Play Exploration and Early Development Intervention (SPEEDI) supports parents, helping them build capacity to provide developmentally supportive opportunities starting in the NICU and continuing at home. The purpose of this single blinded randomized pilot clinical trial was to evaluate the initial efficacy of SPEEDI to improve early reaching and exploratory problem solving behaviors. Methods Fourteen infants born very preterm or with neonatal brain injury were randomly assigned to SPEEDI or Usual Care. The SPEEDI group participated in 5 collaborative parent, therapist, and infant interventions sessions in the NICU (Phase 1) and 5 at home (Phase 2). Parents provided daily opportunities designed to support the infants emerging motor control and exploratory behaviors. Primary outcome measures were assessed at the end of the intervention, 1 and 3 months after the intervention ended. Reaching was assessed with the infant supported in an infant chair using four 30 s trials. The Early Problem Solving Indicator was used to evaluate the frequency of behaviors during standardized play based assessment. Effect sizes are including for secondary outcomes including the Test of Infant Motor Performance and Bayley Scales of Infant and Toddler Development. Results No group differences were found in the duration of toy contact. There was a significant group effect on (F1,8 = 4.04, p = 0.08) early exploratory problem-solving behaviors with infants in the SPEEDI group demonstrating greater exploration with effect sizes of 1.3, 0.6, and 0.9 at the end of the intervention, 1 and 3 months post-intervention. Conclusions While further research is needed, this initial efficacy study showed promising results for the ability of SPEEDI to impact early problem solving behaviors at the end of intervention and at least 3 months after the intervention is over. While reaching did not show group differences, a ceiling effect may have contributed to this finding. This single blinded pilot RCT was registered prior to subject enrollment on 5/27/14 at ClinicalTrials.Gov with number NCT02153736

โปรแกรมการส่งเสริมพัฒนาการของทารกคลอดก่อนกำหนดแบบเบ็ดเสร็จ ขณะรักษาตัวในโรงพยาบาล: การศึกษานำร่อง The Comprehensive Preterm Infant Developmental Care Program in Hospitalized Preterm Infants: A Pilot Study

  Abs บทคัดย่อ   วัตถุประสงค์: เพื่อศึกษาความเป็นไปได้ของโปรแกรมการส่งเสริมพัฒนาการของทารกคลอดก่อนกำหนดแบบเบ็ดเสร็จต่อการรับรู้สมรรถนะแห่งตนของผู้ปกครอง การเจริญเติบโตและพัฒนาการด้านประสาทพฤติกรรมของทารกคลอดก่อนกำหนดขณะรักษาตัวในโรงพยาบาล วิธีการศึกษา: การศึกษานำร่องนี้เป็นการวิจัยกึ่งทดลองเปรียบเทียบกลุ่มเดียววัดผลก่อน-หลังการทดลองและติดตามผล กลุ่มตัวอย่างคัดเลือกโดยใช้เทคนิคการสุ่มกลุ่มตัวอย่างอย่างง่าย เป็นผู้ปกครองและทารกคลอดก่อนกำหนดอายุครรภ์ 28 - 32 สัปดาห์ ที่รักษาตัวในหอผู้ป่วยทารกแรกเกิดวิกฤต โรงพยาบาลชลบุรี 10 ราย รวบรวมข้อมูล 4 สัปดาห์ โดยจัดกิจกรรมเป็นรายบุคคลใช้เวลา 1 สัปดาห์ จำนวน 4 ครั้งๆ ละ 60 - 90 นาที ครอบคลุมกิจกรรมทั้ง 6 ระยะ เครื่องมือที่ใช้เก็บรวบรวมข้อมูลประกอบด้วยแบบประเมินพัฒนาการด้านประสาทพฤติกรรมของทารก เครื่องชั่งน้ำหนัก เทปวัด และแบบสอบถามการรับรู้สมรรถนะแห่งตนในการเลี้ยงดูทารกของผู้ปกครอง วิเคราะห์ข้อมูลโดยใช้สถิติเชิงพรรณนา และสถิติความแปรปรวนทางเดียวแบบวัดซ้ำ ผลการศึกษา: หลังการเข้าร่วมโปรแกรมกลุ่มตัวอย่างมีค่าเฉลี่ยคะแนนการรับรู้สมรรถนะแห่งตน การเจริญเติบโตและพัฒนาการด้านประสาทพฤติกรรมของทารกคลอดก่อนกำหนดระยะหลังการเข้าร่วมโปรแกรมและระยะติดตามผลเพิ่มขึ้นกว่าในระยะก่อนเข้าร่วมโปรแกรมอย่างมีนัยสำคัญทางสถิติที่ P-value < 0.01 กลุ่มตัวอย่างมีความพึงพอใจในกิจกรรมของโปรแกรม สรุป: โปรแกรมการดูแลพัฒนาการของทารกคลอดก่อนกำหนดแบบเบ็ดเสร็จมีความเป็นไปได้ที่จะนําทดสอบในการศึกษาหลัก โดยทดลองกับกลุ่มตัวอย่างที่ใหญ่ขึ้น คำสำคัญ: โปรแกรมการส่งเสริมพัฒนาการแบบเบ็ดเสร็จ, ทารกคลอดก่อนกำหนด, ประสาทพฤติกรรม, สมรรถนะแห่งตน tract Objective: To examine the feasibility of the comprehensive preterm infant developmental care program on parental self-efficacy, growth and neurobehavioral development of hospitalized preterm infants. Methods: This pilot study was a quasi-experimental design with a one-group comparison, pre-posttest, and follow-up. Ten parent-preterm infant dyads were recruited by using a simple random sampling technique. Preterm infants were born at a gestational age of between 28 – 32 weeks and were hospitalized in the NICU at Chon Buri Hospital, Muang district, Chon Buri province, Thailand. Data were collected for 4 weeks. The program was carried out at a hospital with individuals, which contained activities of one week’s duration, including six stages within four sessions. Each session lasted 60 - 90 minutes. Questionnaire consisted of the Neonatal Neurobehavioral Examination, a digital weight scale, a measuring tape, and the Perceived Maternal Parenting Self-Efficacy. Data were analyzed by using descriptive statistics and repeated measures ANOVA. Results: The scores of parental self-efficacy, preterm infant growth, and neurobehavioral development at post-test and follow-up were significantly higher than the pre-test (P-value < 0.01 for all). The parents were satisfied with the program’s activities. Conclusion: The comprehensive preterm infant developmental care program was feasible for further studies with a larger sample size. Keywords: comprehensive preterm infant developmental care program, preterm infants, neurobehavioral development, self-efficac

Enabling Occupational Competence Through Stress Reduction for Parents in the Neonatal Intensive Care Unit (NICU)

Each year, thousands of infants are admitted to the Neonatal Intensive Care Unit (NICU). Research has shown evidence that parents, of babies who are admitted to the NICU, experience increased stress levels and are at an increased risk for mental health issues after discharge from the hospital. The objective of this scholarly project was to develop an occupation-based group protocol that focuses on enabling an occupational adaptive response for parents in the NICU, through the use of evidenced-based stress reduction techniques. An extensive literature review was conducted to identify research to be used to support the development of this product. The product, Stress Reduction for Parents in the NICU: A Five Session Group Protocol, was created based off the evidence found in the literature review, Cole’s Seven Steps, and the Occupational Adaptation model. This group protocol was designed for occupational therapy professionals to use with parents who have infants admitted to the NICU. Each session incorporates individual objectives specific to the nature of the session. All sessions share the common goal of reducing stress as a barrier to fulfillment of their occupational role as a parent. The product includes a detailed outline for each session for therapists to follow during facilitation and corresponding handouts for parents. Finally, the authors included an assessment in the form of a Likert-Scale survey to determine the efficacy of the product

Impact of Cue-Based Feeding Protocol on Premature Infants\u27 Outcomes and Hospital Length of Stay

The project was an oral feeding practice change from traditional, gestational-age/volume-driven feeding progression to developmentally-based, infant-driven feeding progression. The infant-driven (cue-based) feeding protocol was implemented with goals to improve premature infants\u27 feeding outcomes, and decreased the infant\u27s length of hospitalization. The project was designed to implement a cue-based feeding protocol for oral feeding initiation and progression, within the neonatal intensive care unit (NICU) at Community Regional Medical Center (CRMC), and then retrospectively evaluate the impact of the cue-based feeding protocol on feeding outcomes. In order to realize full implementation of a NICU feeding practice change, multiple components, such as electronic charting, feeding policy, staff education and data reports, needed to be developed. Multiple unit- and hospital-level barriers prevented timely project implementation. Given the DNP program time constraints for project implementation, and the complex nature of project review and approval by nursing leadership, final, post-protocol data collection and analysis could not be completed. Delays in project implementation did not allow for oral feeding outcome evaluation, as originally proposed, however, the project did produce valuable instruments for recording and measuring feeding outcomes in the future. Future plans for project follow-up have been established by NICU nursing leadership. Data for 6-month and 1-year feeding outcomes will be collected and evaluated, with the intention to present results to: 1) CRMC corporate leadership, 2) CPQCC 1-year collaborative follow-up (June 2014); and 3) Central Valley Nursing Research Conference 2015

Mental health care for parents of babies with congenital heart disease during intensive care unit admission: Systematic review and statement of best practice

INTRODUCTION: Congenital heart disease (CHD) is one of the most common causes of infant admission to pediatric intensive care and is associated with profound psychological stress for mothers, fathers and their infants. Intensive care unit admission represents an opportunity to offer evidence-based strategies to prevent or minimize severe psychological distress and promote secure bonding and attachment, alongside high-quality infant medical care. OBJECTIVES: We aimed to identify, synthesize and critically appraise published evidence on the efficacy and cost-effectiveness of mental health interventions delivered in neonatal, pediatric or cardiac intensive care units for parents of infants with CHD. A secondary goal was to develop recommendations for advancing health policy, practice and research in the field. METHODS: In accordance with a prospectively registered protocol (CRD42019114507), six electronic databases were systematically searched for studies reporting results of a controlled trial of a mental health intervention for parents of infants aged 0-12 months with a congenital anomaly requiring intensive care unit admission. To maximize generalizability of results, trials involving infants with any type of structural congenital anomaly requiring surgery were included. Outcomes included intervention type, process, efficacy, and cost-effectiveness. RESULTS: Across all forms of congenital anomaly, only five trials met inclusion criteria (four in CHD, one in gastrointestinal malformation). All interventions engaged parents face-to-face, but each had a distinct therapeutic approach (parent-infant interaction and bonding, early pediatric palliative care, psycho-education, parenting skills training, and family-centered nursing). Four of the five trials demonstrated efficacy in reducing maternal anxiety, although the quality of evidence was low. Positive results were also found for maternal coping, mother-infant attachment, parenting confidence and satisfaction with clinical care, as well as infant mental (but not psychomotor) development at 6 months. Mixed results were found for maternal depression and infant feeding. No evidence of efficacy was found for improving parent, infant or family quality of life, physical health or length of infant hospital stay, and there were no data on cost-effectiveness. CONCLUSIONS: Stronger evidence for the efficacy of mental health interventions to buffer the effects of intensive care unit admission for parents of infants with CHD is urgently needed. Robust, high-quality trials are lacking, despite the established need and demand, and health policies prioritizing parent mental health care in the context of early childhood adversity are needed

Increasing Knowledge, Motivation and Self-Efficacy of NICU Nurses on Family Integrated Care

Problem. Can an education session on the family-integrated care model increase NICU nurses’ knowledge, motivation and self-efficacy to implement the role transitions needed to practice within a FIC model? Purpose. Measure if an educational training session would increase knowledge, motivation and self-efficacy of nurses to work in a FIC model of care NICU. Goal/Objectives. Following an online educational training, NICU staff will demonstrate, through self-report instrument, an increase in: Knowledge of benefits of FIC, knowledge of role transition required, motivation to adapt role change and belief in the ability to implement role change. Plan. Descriptive pre-test post-test design using a convenience sample technique with a multiple- choice self-report instrument tool. Results. The study identified the significance of an online educational program in increasing the knowledge, motivation and self-efficacy of NICU nurses about FIC. Recommendations. Ongoing periodical educational intervention can result in improved buy in on FIC hence efforts should be made to educate nurses on the benefits of FIC occasionally

Social Determinants of Health and Parenting Self-Efficacy Among Mothers of Preterm Infants

Objective: To explore the relationships between social and environmental factors and parenting self-efficacy (PSE) among mothers of preterm infants hospitalized in neonatal intensive care units (NICUs) using a social determinants of health (SDoH) framework. Method: We analyzed data from a prospective cohort study that included 187 mother-infant dyads admitted to four NICUs in the Mountain West region between June 2017 and December 2019. We used multivariable linear regression models to assess the independent associations between maternal and infant characteristics and PSE. Results: Our final multiple linear regression model predicting the efficacy score including maternal race/ethnicity, age, insurance, employment status before giving birth, gestational age, depression, and having other children was significant (F(12,160) = 3.17, p = .0004, adjusted R¬2 = .131). Significant predictors of PSE were race/ethnicity (β= 3.3, p = .022), having another child/children (β= 4.2, p = .005), and depression (β= -4.2, p = .004). Conclusions: Findings suggest that social workers and medical practitioners should consider SDoH, such as insurance type, household income, and employment, along with traditional clinical indicators when assessing families’ infant care needs. Social workers, medical practitioners, and researchers should be mindful of how implicit bias may influence the allocation of care and parental supports

Reducing stress in the neonatal intensive care unit:an occupational therapy approach to preterm infant massage

Thesis (Ph.D.)--Boston UniversityPreterm infants and their parents in the neonatal intensive care unit (NICU) are a growing client population for occupational therapists. The NICU environment of care can be over stimulating and cause high amounts of stress for preterm infants and their parents. Evidence-based literature supports preterm infant massage to decrease stress for preterm infants and improve overall neurobehavioral development. Evidenced-based literature also supports decreased stress for parents that perform preterm infant massage with their child as well as improved confidence of parental skills and infant-parent attachment. Despite these benefits, infant massage is practiced in less than half of the NICUs in the United States (Field, Diego & Hernandez-Reif, 2010). This may be related to the underlying mechanisms not being well understood and/or cost effectiveness considerations. This doctoral project (1) identifies evidenced-based literature to support the benefits of preterm infant massage for both the infant and the parent, (2) investigates evidence and best practice in designing a preterm infant massage parent education program in the NICU that supports the infant-parent dyad, (3) provides an overview of best practice for implementing a preterm infant massage parent education program in the NlCU, (4) describes a detailed evaluation plan and dissemination of the results including estimated budgets for implementation and dissemination. This project's target audiences are medical directors, directors of occupational therapy departments, neonatal occupational therapists, neonatologists, other health care staff in the NICU, and parents of preterm infants in the NICU. This project will be presented to the medical director of a Level IV NlCU and the director of occupational therapy at University of Rochester Medical Center-Golisano Children's Hospital for consideration of implementation. This project contributes to three areas of occupational therapy: (1) addressing best practice for implementing a preterm infant massage program in the NlCU to reduce stress levels for infants and parents, (2) providing more evidenced-based practice with a growing occupational therapy population of preterm infants and their parents, and (3) building a more diverse occupational therapy profession