Call for change in care culture: Close Collaboration with Parents intervention proves efficient in increasing parent-infant closeness in the Neonatal Intensive Care Unit (NICU)

Physical and emotional closeness between parents and their newborn infant is important for the development of both preterm and term-born infants. In addition to that, separating parents and infants during newborn care may lead to severe emotional stress and depression in parents and eventually compromise parenting. Another concern that cannot be dismissed is that separation policies can lead to late and long-term consequences for babies. These consequences can be physical or behavioural problems. On the contrary, it is shown that parents’ involvement in infants’ care in hospital enhance long-term cognitive and neurobehavioral development of preterm infants. Moreover, increased parental presence shorten infants’ hospital stays. Skin-to-skin care (SSC) is an efficient way to use the closeness of parents and child positively for both parties as it reduces emotional stress, strengthens bonding and supports the transition into new parental roles. Yet it is by far not only about the bonding process: a large meta-analysis has shown that SSC reduces mortality, infections, and hospital readmissions, increases the volumes of expressed milk and the duration of breastfeeding. In their experimental study, Lehtonen, Axelin, Ahlqvist-Björkroth et al. compared the situation before and after the intervention. This intervention study was carried out stepwise over a period of about 6 years, in nine NICUs in Finland, including two level III hospitals and seven level II hospitals.

© Quirin Leppert/EFCNI

Parents were recruited to participate 3 months before and after the Close Collaboration with Parents intervention took place. The participating parents separately kept diaries where they separately filled in the time they spent in the hospital and the time of skin-to-skin contact with their newborn during each hospital visit until discharge in diaries. After the intervention, the results were evaluated and compared showing that the collaboration programme had increased the time either one parent was present and the time spent providing SSC had also significantly increased. Unlike many earlier studies which have usually focused on mothers’ presence only this one at hand explicitly included the role of fathers or partners in the study design. The program should in fact emphasize that SSC given by mothers and fathers or partners is equally beneficial for the child, and both parental units report SSC as meaningful for them.

Aiming for change in care culture

The Close Collaboration with Parents intervention aimed to improve the skills of neonatal staff to collaborate with parents and was found to substantially increase parents’ presence and SSC in the participating hospitals. The study aimed to fill the knowledge gap related to the facilitation of parent-infant closeness. They concluded that parent-infant closeness might much rather be supported by developing the collaborative skills of neonatal staff. Additionally, it has been shown that a trusting relationship between staff and parents decreases reported stress and supports participation in infant care.

One can conclude that Parent-infants closeness is likely to be an important mediating mechanism for the benefits of parenting interventions. A consistent family-centred care culture so that the entire staff works in partnership with parents is likely to promote parents’ presence and, thereby, create a better developmental environment for preterm infants. Systematic training of professionals enhances family-centred care culture.

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