Family-centered care (FCC) in neonatal intensive care units (NICUs) is a collaborative approach that involves the newborn’s family in neonatal care. FCC is a fundamental component of modern neonatal care which is offering significant health benefits for both parents and their infants. The fundamental principles of FCC involve sharing valuable information, respect and dignity, contribution, engaging in negotiation, and promoting cooperation, all grounded in shared responsibility and mutual trust.
The implementation of FCC in routine practice remains challenging for healthcare organizations. It requires alterations in the mindsets and behaviors of NICU’s staff and adaptations to the NICU’s organizational structure. Several studies have been established to assess the effects of FCC interventions on several outcomes but there is limited information available about how they directly affect FCC practices. To enhance FCC, NICU staff can participate in “close collaboration with parents intervention”, a structured educational program. As a result of this program, FCC practices were improved in 8 Finnish NICUs with fidelity rates from 46% to 100%.
Ryo Itoshima et al. evaluate the efficacy and fidelity of close collaboration with parents’ intervention programs and assess the role of fidelity in improving FCC practices. This prospective non-randomized clinical trial (NCT06258655) was published in JAMA Network Open on January 9, 2025. This multi-centered clinical study was conducted at 6 NICUs in three hospitals in Estonia. The close collaboration with parents’ intervention program was implemented at all NICUs and data was collected for pre-intervention (from March to August 2021) and post-intervention (from December 2022 to June 2023) periods. The quality of FCC is measured using the Digi Family-Centered Care–Parent version tool for parents and the Digi Family-Centered Care–Nurse version tool for NICU staff.
A total of 99 NICU staff completed training comprising 21% physicians, and 58% midwives or nurses. The fidelity rate was higher than the median in 3 NICUs (37/45 in units E and F, 13/18 in C) and lower in the other 3 NICUs (16/34 in B, 8/29 in A, and 4/30 in D). A total of 186 infants (50.5% male) with a median gestational age of 37.4 (interquartile range [IQR]: 34.0-39.9 weeks) were involved in the pre-intervention period and responses collected from 186 mothers and 22 fathers with median parental age of 32 (IQR: 28-36 years). In contrast, a total of 208 infants (55.1% male) with a median gestational age of 38.1 (IQR: 35.4-39.9 weeks) were involved in the post-intervention period, and responses collected from 208 mothers and 55 fathers with a median parental age of 32 (IQR: 27-35 years).
NICU staff members provided 7448 daily responses during the pre-intervention period and 6717 during the post-intervention period. The fidelity rates were significantly higher in the post-intervention period compared to the pre-intervention period for both staff (correlation coefficient [r] = 0.10 and P < 0 .001) and parents (r = 0.07 and P < 0.001). However, median overall ratings were not changed during pre-intervention and post-intervention periods among both staffs (pre 6.0 [IQR: 5.0-7.0] and post 6.0 [IQR: 6.0-7.0]) and parents (pre and post 7.0 [IQR: 6.0-7.0]). Moreover, implementation fidelity among healthcare providers changed from 13.3% (4/30) to 82.2% (37/45) across all 6 NICUs. NICUs with high fidelity rates showed greater statistical significance improvement in FCC practices by the staff members during the post-intervention period (β = 2.1 [95% confidence interval: 0.8-3.4] and P = 0.002).
“Our findings concluded that implementation of the close collaboration with parents intervention program in NICUs leads to improvement in FCC practice among staff and parents. Additionally, high fidelity played a major role in these improvements. The staff members also reported greater improvement in FCC than parents after the intervention program. Further, it enhances the mutual understanding, trust, and shared responsibilities among parents and NICU staff. Future research should explore strategies to achieve high fidelity and maximize the impact of close collaboration with parents,” says Ryo Itoshima, MD, Department of Clinical Medicine, University of Turku, Finland.
Reference: Itoshima R, Varendi H, Toome L, et al. Outcomes Following Close Collaboration With Parents Intervention in Neonatal Intensive Care Units: A Nonrandomized Clinical Trial. JAMA Netw Open. 2025;8(1):e2454099. doi:10.1001/jamanetworkopen.2024.54099
