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Published on: January 7, 2020
Family-Centered Care to Complement Care of Sick Newborns: A Randomized Controlled Trial
Ankit Verma1, Arti Maria, Ravindra Mohan Pandey
1Departments of Pediatrics and $Microbiology, PGIMER and Dr. RML Hospital; *Biostatistics, AIIMS; and #Management Studies, IIT; New Delhi, India. Correspondence to: Dr Arti Maria, Neonatal Division, Department of Pediatrics, PGIMER and Dr. RML Hospital, Baba Kharak Singh Marg, New Delhi, India 110 001. artimaria@gmail.com.
Insights
Family-centered care in neonatal intensive care units did not reduce nosocomial infections. However, this approach significantly improved exclusive breastfeeding rates before hospital discharge.
Area of Science:
- Neonatal intensive care
- Infection control
- Family-centered care
Background:
- Nosocomial infections are a significant concern in neonatal intensive care units (NICUs).
- Family-centered care models aim to integrate families into patient care.
- The impact of family-centered care on infection rates and other outcomes in sick newborns requires further investigation.
Purpose of the Study:
- To evaluate the effect of family-centered care on the rate of nosocomial infections in sick newborns.
- To assess secondary outcomes including hospitalization duration, mortality, and breastfeeding rates.
Main Methods:
- A randomized controlled trial was conducted in a tertiary referral nursery from October 2010 to March 2012.
- 295 neonates admitted to the NICU were randomized.
- The intervention group received training on hygiene and infant care, while the control group received standard care.
Main Results:
- There was no statistically significant difference in the incidence of culture-positive nosocomial sepsis between the intervention and control groups.
- Pre-discharge exclusive breastfeeding rates were significantly higher in the family-centered care group (80.4% vs. 66.7%, P=0.007).
Conclusions:
- Family-centered care did not significantly reduce nosocomial infection rates in sick newborns.
- Implementing family-centered care principles was feasible and positively impacted exclusive breastfeeding rates prior to discharge.
Objective:
To assess the impact of family-centered care in delivery of care to sick newborns, on nosocomial infection rate.
Design:
Randomized controlled trial.
Setting:
Tertiary referral nursery (October 2010 to March 2012).
Participants:
295 neonates randomized at the time of hospitalization in neonatal intensive care unit.
Intervention:
Parent-attendant of intervention group were trained using an indigenously developed and pretested, culturally sensitive, simple audio-video tool that covered domains of personal hygiene, hand washing, danger signs recognition and feeding of sick neonate. Control group received routine care by nurses and doctors.
Outcome Measure:
Primary: culture positive nosocomial infection rate. Secondary: culture negative nosocomial infection rate, duration of hospitalization, mortality and breastfeeding rate.
Results:
Two-thirds of family caregivers were fathers/ mothers and about 20% were grandparents. About 60% of family care givers were either illiterate (25%) or primary/middle pass (34%). Incidence of nosocomial episodes of sepsis was not different between groups (incidence rate difference 0.74, 95 % CI -4.21, 5.6, P = 0.76). Pre-discharge exclusive breastfeeding rates were significantly higher in intervention group [80.4% vs 66.7% (P=0.007)].
Conclusion:
There was no significant difference in nosocomial infection rate between the two groups. Translating and adapting principles of family-centered care was feasible, and improved the pre-discharge exclusive breastfeeding rates.
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