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Family Integrated Care for Preterm Infants in China: A Cluster Randomized Controlled Trial
Mingyan Hei1, Xiangyu Gao2, Ying Li3
1Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China; National Center of Children's Health, Beijing, China.
Insights
Family Integrated Care (FICare) in China significantly reduced preterm infant hospital stays and costs. This approach improved infant outcomes, including weight gain and breastfeeding rates, while lowering infection risks.
Area of Science:
- Neonatal Intensive Care
- Pediatric Health Outcomes
- Healthcare Intervention Studies
Background:
- Family Integrated Care (FICare) involves parents actively in their infant's care within the Neonatal Intensive Care Unit (NICU).
- Previous studies suggest FICare benefits, but its feasibility and impact in diverse healthcare settings like China remain under-explored.
Purpose of the Study:
- To assess the feasibility of implementing Family Integrated Care (FICare) in Chinese NICUs.
- To evaluate the impact of FICare on clinical outcomes for preterm infants.
Main Methods:
- A multicenter prospective cluster-randomized controlled trial was conducted.
- Compared FICare with standard care in 601 preterm infants across 11 NICUs.
- Primary outcome: length of stay (LOS); Secondary outcomes: nosocomial infections, oxygen use, breastfeeding, weight gain.
Main Results:
- FICare implementation was feasible and associated with significant improvements.
- Reduced length of stay (LOS) by 19% and medical expenditures by 31%.
- Improved weight gain velocity, increased breastfeeding rates by over 50%, and decreased nosocomial infections and rehospitalization rates.
Conclusions:
- Family Integrated Care (FICare) is a viable and beneficial model for Chinese NICUs.
- FICare significantly reduces hospital length of stay, costs, and adverse events in preterm infants.
- The positive effects of FICare on infant outcomes, including breastfeeding and weight gain, are sustained long-term.
Objective:
To explore whether family integrated care (FICare) is feasible and improves the outcomes of preterm infants in China.
Study Design:
This was a multicenter prospective cluster-randomized controlled trial comparing FICare and standard care. The primary outcome was length of stay (LOS). Secondary outcomes were nosocomial infections, duration of supplemental oxygen, breastfeeding, and weight gain. Outcomes were compared using univariate and multivariable analyses adjusted for potential confounders and clustering.
Results:
We enrolled 601 preterm infants from 11 neonatal intensive care units (FICare, n = 298; control, n = 303). The unadjusted LOS was 30.81 vs 30.26 days (mean ratio, 1.02; 95% CI, 0.85-1.22; P = .85). After adjustment, outcomes in the FICare group were improved compared with the control group, including LOS (28.26 vs 35.04 days; mean ratio, 0.81; 95% CI, 0.72-0.91), total medical expenditures (mean ratio, 0.69; 95% CI, 0.53-0.90), weight gain velocity (15.73 vs 10.30 g/day; mean difference, 5.43; 95% CI, 3.65-7.21), duration of supplemental oxygen (13.11 vs 21.42 days; mean difference, 0.71; 95% CI, 0.50-1.00), nosocomial infection rates (4.13 vs 5.84/1000 hospital days; mean ratio, 0.67; 95% CI, 0.47-0.96), antibiotic exposure (38.63 vs 57.32/100 hospital days; mean ratio, 0.67; 95% CI, 0.47-0.96), breastfeeding rates (87.25% vs 55.78%; OR, 5.42; 95% CI, 3.25-9.05), and rehospitalization rates (3.65% vs 7.48%; OR, 0.47; 95% CI, 0.28-0.77). At follow-up to 18 months, breastfeeding rates and weight were significantly (P < .05) higher over time in the FICare group.
Conclusions:
FICare was feasible in Chinese neonatal intensive care units and was associated with reduced hospital LOS, medical expenditures, and rates of adverse outcomes.
