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Updated: Jun 26, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Eight principles for newborn care in neonatal units: Findings from a national survey
Maria Lopez-Maestro1, Javier De la Cruz2, Josep Perapoch-Lopez3
1Division of Neonatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Insights
Infant and family-centered developmental care (IFCDC) principles are not fully implemented in Spanish neonatal units. Newborn positioning is highest, while pain management is lowest, with more principles applied in units with higher very low birth weight infant volumes.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Healthcare quality assessment
Background:
- Infant and family-centered developmental care (IFCDC) principles are crucial for optimizing neonatal outcomes.
- A European expert group defined eight core IFCDC principles in 2018.
- Assessing the national-level implementation of these principles is essential for quality improvement.
Purpose of the Study:
- To evaluate the national implementation status of eight IFCDC principles in Spanish neonatal intensive care units.
- To identify variations in the adoption of IFCDC principles across different neonatal units.
- To explore factors associated with the implementation of IFCDC principles.
Main Methods:
- A nationwide survey was distributed to level-III Spanish neonatal units.
- Implementation of each principle was determined by positive responses to associated survey questions.
- A response rate of 84.5% (65/77 units) was achieved.
Main Results:
- No unit had implemented all eight IFCDC principles.
- Principle 5 (postural support) showed the highest implementation rate (84.6%), while Principle 3 (pain management) had the lowest (7.7%).
- Units caring for a higher number of very low birth weight (VLBW) infants showed a trend towards implementing more IFCDC principles.
Conclusions:
- Significant gaps exist in the national implementation of IFCDC principles in Spanish neonatal care.
- Prioritizing pain management and ensuring comprehensive IFCDC implementation are critical areas for improvement.
- Higher volume VLBW units may be better equipped or more focused on implementing IFCDC principles.
Aim:
To assess, at national level, the implementation of eight principles for infant- and family-centred developmental care (IFCDC) in neonatal units. A European expert group established eight 'Principles of care' in 2018 that define neurodevelopmental and family-centred care.
Methods:
The implementation of each principle was assessed by a survey sent to level-III Spanish units. A principle was considered to be implemented if all answers to the principle-associated questions were positive.
Results:
The response rate was 84.5% (65/77). No unit had implemented eight principles. Principle 1 (free parental access) was implemented in 21.5% of the centres; Principle 2 (psychological support) 40%; Principle 3 (pain management) 7.7%; Principle 4 (environmental influences) 29%; Principle 5 (postural support) 84.6%; Principle 6 (kangaroo-care) 67.7%; Principle 7 (breastfeeding) 23% and Principle 8 (sleep protection) in 46%. In units attending ≥50 very low birth weight (VLBW) infants, four or more principles had been implemented in 31% vs 13% <50 VLBW neonates (odds ratio 3.0 CI 95% 0.9-10.1, P .07).
Conclusion:
The principle with the highest implementation was related to newborn body positioning. Pain management was the principle with lowest implementation. More principles for IFCDC tend to be implemented in units providing care for a higher number of VLBW infants.
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