Paeds Cases · fetal-neonatal-and-perinatal
Family-integrated developmental care in NICU
Clinical case of a preterm infant whose mother, participating in a FiCare programme, develops stress and depressive symptoms with suboptimal infant weight gain, requiring integrated clinical and family-centred management.
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Target exams
RACP DCEMRCPCH ClinicalABP General Pediatrics
Prompt
A former 27-week gestation infant (birth weight 880 g), now 32 weeks postmenstrual age, is 5 weeks into a tertiary NICU stay on a Family Integrated Care programme. The mother, who has been present daily and completing the structured education sessions, tells the bedside nurse she is exhausted and 'not coping'. Weight-gain velocity over the past week has been 10 g/kg/day against a target of 15 to 20 g/kg/day. The infant is otherwise stable on low-flow oxygen and full enteral feeds of expressed breast milk.
Case framework
This long case examines whether the candidate can integrate clinical and family-centred reasoning. The infant is medically stable but growing below target, and the mother — the intended primary caregiver — is showing signs of stress and possible depression. The trap is to treat these as separate problems; the teaching point is that they are linked and that the FiCare model itself, when poorly calibrated, can contribute to parental burnout. [1]
References4ShowHide
- [1]O'Brien K, Robson K, Bracht M, et al Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial Lancet Child Adolesc Health, 2018.PMID 30169298
- [2]Zhang Y, Jiang M, Wang S, et al. Effect of family integrated care on stress in mothers of preterm infants: A multicenter cluster randomized controlled trial J Affect Disord, 2024.PMID 38232775
- [3]Symington A, Pinelli J Developmental care for promoting development and preventing morbidity in preterm infants Cochrane Database Syst Rev, 2006.PMID 16625548
- [4]Conde-Agudelo A, Díaz-Rossello JL Kangaroo mother care to reduce morbidity and mortality in low birthweight infants Cochrane Database Syst Rev, 2016.PMID 27552521