184 - The effect of strategies to increase family involvement in the care of hospitalized preterm or low birthweight infants on infant and parental outcomes: a systematic review and meta-analysis.

Poster Number: 184
Publication Number: 184.234

Krysten North, Harvard Medical School, Boston, MA, United States; Rachel Whelan, Harvard Medical School, Boston, MA, United States; Lian V. Folger, Brigham and Women's Hospital, Durham, NC, United States; Ingrid E. Olson, Brigham and Women's Hospital, Boston, MA, United States; Harriet L. Lawford, Mater Research Institute - The University of Queensland, Brisbane, Queensland, Australia; Sophie Driker, Tufts University School of Medicine, Boston, MA, United States; Michelle B. Bass, Countway Library of Medicine, Harvard Medical School, Boston, MA, United States; Anne C. Lee, Brigham and Women's Hospital, Department of Pediatric Newborn Medicine; Harvard Medical School, Boston, MA, United States

Background: Low-birthweight (LBW) and preterm infants require special care and are often separated from parents during their hospitalization. Family participation in the routine care of small and sick newborns may benefit both infant health and parental well-being.

Objective: To evaluate the effectiveness of intervention strategies to increase family involvement in routine hospital care of preterm or LBW infants, as compared to standard neonatal intensive care, on infant outcomes and hospital utilization.

Design/Methods: We systematically searched PubMed, Embase (Elsevier), Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO), and World Health Organization (WHO) Global Index Medicus. We included randomized controlled trials (RCTs) of intervention packages for which the primary objective was to increase family participation in direct bedside routine newborn care of preterm/LBW infants. We excluded studies of single interventions such as kangaroo mother care or early intervention. We used standard Cochrane methods for data extraction, risk of bias assessment, and assessing the quality of evidence. Prospero registration: CRD42021269013.

Results: We included 21 reports of 15 RCTs with 5240 participants. All trials tested packages of family involvement, with content including parental bedside care (n=15), parent education (n=13), developmental care (n=8), discharge planning (n=6), and psychosocial support (n=4). Family involvement strategies reduced the rate of retinopathy of prematurity (OR 0.52, 95% CI: 0.34-0.80; 8 RCTs) and the mean length of hospital stay (MD -2.91 days; 95% CI: -5.15 to -0.82; 11 RCTs). Also, infants in the intervention group had higher weight gain velocity during their hospitalization (MD 2.09 g/day; 95% CI 1.27-2.91; 3 RCTs), higher neurobehavioral exam scores at discharge (Neonatal Neurobehavioral Examination; MD: 1.11; 95% CI 0.21 to 2.01; 2 RCTs), and higher rates of predominant or exclusive breastmilk intake at discharge (OR 1.34; 95% CI 1.01 to 1.65; 3 RCTs). No significant differences between groups were found for the outcomes of bronchopulmonary dysplasia, in-hospital infection, mortality, necrotizing enterocolitis, intraventricular hemorrhage, or breastmilk-feeding at discharge (Figure 3).Conclusion(s): This review provides low to moderate quality (GRADE) evidence to support the beneficial role of family involvement strategies in a range of infant outcomes and hospitalization.
Figure 1: PRISMA flow diagram of study selection.
Figure 2: Family involvement strategies conceptual framework with key components and outcomes.