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Parental involvement and kangaroo care in European neonatal intensive care units: a policy survey in eight countries
Carmen R Pallás-Alonso1, Valentina Losacco, Alice Maraschini
1Department of Neonatology-SAMID, 12 de Octubre University Hospital, Madrid, Spain. keka.pallas@gmail.com
Insights
Parental involvement in neonatal intensive care units (NICUs) varies across Europe. While kangaroo care is common, its practice and parental roles differ significantly between countries and between mothers and fathers.
Area of Science:
- Neonatal care practices
- Parental involvement in healthcare
- Cross-cultural healthcare policy
Background:
- Parental presence and participation are increasingly recognized as vital components of neonatal intensive care.
- Kangaroo care, a method of skin-to-skin contact, has demonstrated numerous benefits for premature and low-birth-weight infants.
- Understanding variations in policies and practices is crucial for standardizing and improving family-centered care in neonatal intensive care units (NICUs).
Purpose of the Study:
- To compare parental involvement policies and practices in European neonatal intensive care units (NICUs).
- To assess the implementation of kangaroo care across different European countries.
- To identify differences in the roles and tasks assigned to mothers and fathers within the NICU setting.
Main Methods:
- A prospective multicenter survey was conducted across eight European countries.
- Structured questionnaires were distributed to 362 neonatal intensive care units (NICUs) meeting specific admission criteria.
- Data were collected on parental facilities, involvement policies, and kangaroo care practices.
Main Results:
- Facilities for parents were common but varied geographically, being less prevalent in Italy and Spain.
- Parental participation in infant care was encouraged in most units, with notable policy differences between Northern and Southern European countries.
- Kangaroo care was widely practiced, but restrictions on its frequency, method (skin-to-skin vs. conventional), and conditions were observed, particularly in the UK, France, Italy, and Spain. Fathers were less frequently offered kangaroo care than mothers, and less often in a skin-to-skin manner.
Conclusions:
- While most European NICUs aim to encourage parental involvement, the extent and nature of this involvement differ significantly within and between countries.
- Practices surrounding kangaroo care, including its application to fathers, show considerable variation, highlighting a need for more standardized guidelines.
- Further research is needed to understand the factors driving these variations and their impact on infant and family outcomes.
Objective:
To compare, in a large representative sample of European neonatal intensive care units, the policies and practices regarding parental involvement and holding babies in the kangaroo care position as well as differences in the tasks mothers and fathers are allowed to carry out.
Design:
Prospective multicenter survey.
Setting:
Neonatal intensive care units in eight European countries (Belgium, Denmark, France, Italy, The Netherlands, Spain, Sweden, and the United Kingdom).
Patients:
Patients were not involved in this study.
Interventions:
None.
Measurements And Main Results:
A structured questionnaire was mailed to 362 units (response rate 78%); only units with ≥50 very-low-birth-weight annual admissions were considered for this study. Facilities for parents such as reclining chairs near the babies' cots, beds, and a dedicated room were common, but less so in Italy and Spain. All units in Sweden, Denmark, the United Kingdom, and Belgium reported encouraging parental participation in the care of the babies, whereas policies were more restrictive in Italy (80% of units), France (73%), and Spain (41%). Holding babies in the kangaroo care position was widespread. However, in the United Kingdom, France, Italy, and Spain, many units applied restrictions regarding its frequency (sometimes or on parents request only, rather than routinely), method (conventional rather than skin-to-skin), and clinical conditions (especially mechanical ventilation and presence of umbilical lines) that would prevent its practice. In these countries, fathers were routinely offered kangaroo care less frequently than mothers (p < .001) and less often it was skin-to-skin (p < .0001).
Conclusions:
This study showed that, although the majority of units in all countries reported a policy of encouraging both parents to take part in the care of their babies, the intensity and ways of involvement as well as the role played by mothers and fathers varied within and between countries.
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