Improving FCC in Neonatal ICUs

A study shows that as a result of the “close parent intervention” program, FCC practices were improved in 8 NICUs.

The impact of a collaborative intervention

Ryo Itoshima, MD, Department of Clinical Medicine, University of Turku, Finland, and colleagues assessed the impact of the "Close Collaboration With Parents" program in enhancing family-centered care across six Estonian NICUs. This prospective, multi-center, nonrandomized clinical trial, conducted between 2021 and 2023, highlighted the role of training fidelity in improving care practices, with data collected before and after the intervention phases.

The educational program for NICU staff comprised four key training phases: systematic observation of infant behavior, joint observations to plan care with parents, understanding the family’s unique story, and involving parents in decision-making during medical rounds and discharge planning. These phases were supported by e-learning modules, bedside training, and reflection sessions facilitated by local mentors. The study employed a nonrandomized before-and-after design, including 186 infants pre-intervention and 208 post-intervention. Both parents and staff were surveyed using tools adapted to assess FCC practices.

Results

Improvement in FCC practices - Both parents and staff reported significant improvements in FCC ratings post-intervention. Parental ratings showed gains in areas such as active listening, emotional support, and individualized guidance. Staff ratings particularly showed broader improvements, notably in emotional support, shared decision-making, and trust-building between staff and parents.

Implementation fidelity - The fidelity of the intervention, measured by the proportion of staff completing the training, varied significantly among the NICUs. Units with higher fidelity exhibited greater improvements in FCC ratings, particularly in staff responses (adjusted β = 2.1; p = 0.002). 

Parental and staff perspectives - While parental ratings were already high pre-intervention, incremental improvements were noted in active listening and emotional support. Staff ratings demonstrated more pronounced changes across a wider range of FCC dimensions, reflecting the effectiveness of the training program.

Broader Implications - The study’s findings align with prior research emphasizing the role of FCC in reducing parental stress, improving parent-infant bonding, and enhancing infant outcomes. However, this study is among the first to rigorously assess the impact of implementation fidelity on FCC outcomes.

The implementation of FCC in routine practice remains challenging

The findings underscore the importance of structured educational interventions in enhancing FCC practices. High fidelity in implementation was a critical factor for success, suggesting that comprehensive staff training, consistent mentoring, and a supportive organizational culture are vital for achieving desired outcomes. The intervention’s phased approach allowed for gradual skill-building, enabling staff to better understand and address the unique needs of each family.

However, challenges remain. Variations in engagement levels among NICU staff highlighted the need for tailored strategies to ensure consistent participation. The study also noted differences in how FCC principles were applied across NICUs, influenced by factors such as staffing levels, unit layout (e.g., open-bay versus single-family rooms), and pandemic-related restrictions.

More research needed

The "Close Collaboration With Parents" intervention demonstrates the potential to improve FCC practices in NICUs. Emphasizing implementation fidelity and fostering an inclusive care culture are essential for optimizing outcomes. The intervention’s success in improving staff-parent communication and emotional support underscores the importance of comprehensive training programs in transforming NICU care. Future studies should aim to refine FCC evaluation tools, explore the scalability of such interventions, and address barriers to implementation to ensure wider applicability and sustainability.

The study’s nonrandomized design and reliance on self-reported data may introduce bias. Additionally, the COVID-19 pandemic influenced the training’s delivery and parental access to NICUs, potentially affecting the findings. The high baseline ratings for parental experiences also introduced a ceiling effect, limiting the observable impact of the intervention. Further research is needed to explore long-term impacts, including effects on infant health outcomes and parental mental health.

Sources
  1. Itoshima R, Varendi H, Toome L, Saik P, Axelin A, Lehtonen L, Moazami-Goodarzi A, Ahlqvist-Björkroth S. Outcomes Following Close Collaboration With Parents Intervention in Neonatal Intensive Care Units: A Nonrandomized Clinical Trial. JAMA Netw Open. 2025 Jan 2;8(1):e2454099. doi: 10.1001/jamanetworkopen.2024.54099. PMID: 39786771; PMCID: PMC11718553.
  2. Franck LS, O’Brien K. The evolution of family-centered care: From supporting parent-delivered interventions to a model of family integrated care. Birth Defects Res. 2019;111(15):1044-1059.
  3. Ding X, et al. Effects of family-centered care interventions on preterm infants and parents in NICUs: A systematic review. Aust Crit Care. 2019;32(1):63-75.
  4. Axelin A, et al. Close Collaboration with Parents intervention improves family-centered care in NICUs. Pediatr Res. 2020;88(3):421-428.