The Power of Family Integrated Care in the NICU

As clinicians have come to better understand the parental experience of the NICU, often one of trauma and alienation, neonatology professionals have searched for a way to change that—a way to bring parents closer into the circle of care.

Family Integrated Care (FiCare) is the newest model of neonatal care aimed at reducing the NICU infant-parent separation by making parents critical members of the caregiving team.¹ Piloted all over the world through randomized controlled trials, as reported by Archives of Disease in Childhood, family-integrated neonatal care has shown to be better for parents, infants, and the entire healthcare system.²

Core Components of Family Integrated Care

FiCare welcomes parents into the NICU as equal caregiving partners. In a collaborative partnership with NICU personnel through the use of mentoring and education, parents are empowered to be the primary caregivers of their infants.

Pioneered by neonatal care teams in Canada, the core strategies of FiCare are as follows:³

• Parental education: Trained NICU staff coach parents on how to attend to their infants' medical and developmental needs, such as preparing and providing nutrition, bathing, and reporting updates during rounds. As parents gain comfort with these skills, they are encouraged to participate in the more technical aspects of their child's care, such as suctioning or tube feeding.
• Training staff in FiCare: Training takes a multi-disciplinary approach, teaching nurses, physicians, respiratory therapists, social workers, and other NICU staff how to partner with and teach parents—emphasizing how to relinquish control to parents safely.
• Supportive physical environment: The NICU's physical space is designed to accommodate parents with no clinical knowledge. Intuitive technology is brought in that supports parents' access to their infants.

Family Integrated Care Is Better Care

Numerous studies in Canada, the United Kingdom, and China have all shown the benefits of FiCare. Let's take a look at just a few of these proven benefits in the context of research.

1. Improves Infant Health Outcomes

Recently published in Lancet Child and Adolescent Health, trials in Canada found FiCare led to improved weight gain and increased rates of breastfeeding.⁴ A study in the International Breastfeeding Journal supports this, demonstrating FiCare-supported maternal breastfeeding self-efficacy and rates of breastmilk efficacy in preterm infants, a group traditionally at high risk of difficulty establishing breastfeeding.⁵

Other important infant health outcomes include the following:

• A study in Early Human Development examined the developmental outcomes of infants who experienced FiCare and found persistent improvement in children's self-regulation at 18-21 months old.⁶
• Another Canadian group found better motor development in very preterm infants exposed to FiCare.⁷

2. Boosts Parents' Mental Health

FiCare has been shown to reduce maternal stress and anxiety and support parent-child bonding.^8,9 Those who consistently performed parent-delivered interventions were found to experience less depression in the first year of their child's life.⁹ A qualitative study in Advances in Neonatal Care found that FiCare also encourages parental confidence, helping parents better adjust to their new role.¹⁰

3. Helps the Healthcare System

The Canadian group pioneering FiCare has shown it actually reduces an infant's length of stay in the hospital. This was confirmed in a study performed in Chinese NICUs, published in the Journal of Pediatrics, finding a reduced length of up to one week less, leading to an overall medical cost reduction of about 30%.¹¹

Technology Can Support FiCare

The core tools of FiCare are based on communication and relationships, but smart technology certainly helps. Most NICU technology is too intimidating and overwhelming for parents and families without medical training, requiring a certain level of dependence on staff for data interpretation.

However, the GE Giraffe OmniBed Carestation was designed not only to facilitate optimal neurodevelopment for all babies, but its thoughtful care-focused features also fully support FiCare.

• Large color displays, designed for parents, clearly show vital data like baby weight, growth, and progression helping parents stay better informed of their infants' health.
• Adjustable bed height enables parents to easily see their child from a seated or standing position.
• Clear panels and port holes allow parents to see and touch their infant more easily while ensuring heat is not lost.
• Dependable infant skin temperature monitoring ensures caregivers know the baby's temperature during skin-to-skin time.

The OmniBed Carestation invites family members to nurture, guide, and remain present for their baby's stay in the NICU—bringing babies one step closer to caregivers' expertise, their parents' embrace, and to going home healthy.

Raising the Standard of Care

This mass of data from NICU units implementing FiCare clearly shows that this model could become the new standard of care in neonatal nursing. By thoughtfully and systematically integrating parents into the medical team while taking advantage of the latest in incubator technology, NICU staff can support the growth and development of both the infant patients in their care and parents who want to help.

FiCare is taking confused and powerless parents in NICUs across the world and transforming them into confident, empowered caregivers.

References:

1. Family Integrated Care. FiCare supports the full integration of families in the care of their infants in the NICU. https://familyintegratedcare.com/. Accessed November 14, 2022.
2. Patel N, Ballantyne A, Bowker G, et al. Family integrated care: changing the culture in the neonatal unit. Archives of Disease in Childhood. 2017;103(5):415-419. doi:10.1136/archdischild-2017-313282
3. Waddington C, Veenendaal NR, O'Brien K, et al. Family integrated care: supporting parents as primary caregivers in the neonatal intensive care unit. Pediatric Investigation. 2021;5(2):148-154. doi:10.1002/ped4.12277
4. O'Brien K, Robson K, Bracht M, et al. Effectiveness of family integrated care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. The Lancet Child & Adolescent Health. 2018;2(4):245-254. doi:10.1016/s2352-4642(18)30039-7
5. Brockway M, Benzies KM, Carr E, et al. Breastfeeding self-efficacy and breastmilk feeding for moderate and late preterm infants in the family integrated care trial: a mixed methods protocol. International Breastfeeding Journal. 2018;13(1). doi:10.1186/s13006-018-0168-7
6. Church PT, Grunau RE, Mirea L, et al. Family integrated care (FICare): positive impact on behavioural outcomes at 18 months. Early Human Development. 2020;151:105196. doi:10.1016/j.earlhumdev.2020.105196
7. Synnes AR, Petrie J, Grunau RE, et al. Family integrated care: very preterm neurodevelopmental outcomes at 18 months. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2021;107(1):76-81. doi:10.1136/archdischild-2020-321055
8. Cheng C, Franck LS, Ye XY, et al. Evaluating the effect of family integrated care on maternal stress and anxiety in neonatal intensive care units. Journal of Reproductive and Infant Psychology. 2019;39(2):166-179. doi:10.1080/02646838.2019.1659940
9. Franck LS, O'Brien K. The evolution of family-centered care: from supporting parent-delivered interventions to a model of family integrated care. Birth Defects Research. 2019;111:1044-1059. doi:10.1002/bdr2.1521
10. Broom M, Parsons G, Carlisle H, et al. Exploring parental and staff perceptions of the family-integrated care model. Advances in Neonatal Care. 2017;17(6):12-19. doi:10.1097/anc.0000000000000443
11. Hei M, Gao X, Li Y, et al. Family integrated care for preterm infants in China: a cluster randomized controlled trial. The Journal of Pediatrics. 2021;228:36-43.e2. doi:10.1016/j.jpeds.2020.09.006

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