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Parental Holding Practices in the Neonatal Intensive Care Units in the US: A Survey of Physicians and Advanced
Emily Garavatti1, Tara Calder, Brian Scottoline
1Author Affiliations: Neurology & Center for Neonatal Research, Children's Hospital Orange County, Orange, California (Dr Garavatti); and Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon (Mrs Calder, Dr Scottoline, and Dr Ondusko).
Insights
Parental holding in neonatal intensive care units (NICUs) shows wide practice variability despite known benefits. Standardized guidelines are needed to improve family-centered care and overcome barriers like equipment and staffing.
Area of Science:
- Neonatal care practices
- Family-centered care
- Infant development
Background:
- Parent-infant interaction is vital for infant growth and development.
- Parental holding offers significant health benefits for both infants and parents.
- Understanding current practices in neonatal intensive care units (NICUs) is crucial.
Purpose of the Study:
- To explore parental holding practices in NICUs.
- To identify practices related to common care, equipment, and procedures.
- To understand barriers affecting parental holding.
Main Methods:
- A survey was distributed to physicians and advanced practice providers via the American Academy of Pediatrics (AAP) Section on Neonatal Perinatal Medicine (SoNPM).
- Data analysis involved descriptive statistics and thematic analysis of survey responses.
- Free-text responses were analyzed to identify barriers to parental holding.
Main Results:
- Parental holding was frequently permitted with peripherally inserted central catheters (86%
- always") and conventional ventilators (41% "always").
- Holding was less frequent during therapeutic hypothermia (43% "never"), with chest tubes (25% "never"), and high-frequency ventilation (20% "never").
- Barriers included equipment, infant instability, unit culture, and staffing.
Conclusions:
- Significant variability exists in NICU parental holding practices, despite established benefits.
- No medical intervention universally restricted holding, indicating feasible approaches are possible.
- Developing national standardized guidelines can improve family-centered care and reduce practice variability.
Background:
Healthy parent-infant interaction is crucial for the growth and development of the infant. Specifically, parental holding has substantial health benefits for both the infant and parent.
Purpose:
Exploration of practices for parental holding related to common care, equipment, and procedures in neonatal intensive care units (NICUs).
Methods:
A survey was developed and distributed through the American Academy of Pediatrics (AAP) Section on Neonatal Perinatal Medicine (SoNPM) to physicians and advanced practice providers. Data were analyzed using descriptive statistics and thematic analysis.
Results:
Peripherally inserted central catheters and conventional ventilators had the highest reports of allowing parental holding (86% and 41% reporting "always," respectively) and no reports of "never." Parental holding was infrequently permitted during therapeutic hypothermia, with chest tubes in place and receiving high-frequency ventilation (43%, 25%, and 20% reporting "never," respectively). In the free-text responses, a variety of factors were identified as barriers to parental holding, including equipment limitations, infant clinical instability, and unit culture and staffing.
Implications For Practice And Research:
Despite the known benefits of parental holding, wide variability in NICU holding practices exists. Importantly, no medical intervention in this study was unanimously associated with restricting parental holding, suggesting that safe and feasible approaches to holding exist across clinical contexts. This highlights the critical need to document and disseminate these practices to inform and advance standards of care. The development of national standardized holding guidelines is a viable pathway forward to eliminate variability in individual perceived safety barriers and provide a pathway to improving family-centered care in the NICU.
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