Family-integrated developmental care in NICU

Question 1 (10 marks)

a) Distinguish between developmental care (NIDCAP), family-centred care, and Family Integrated Care (FiCare), defining the parental role in each. (4 marks) Developmental care (NIDCAP) modifies the environment and handling — dim and cycled light, noise below 45 dB, protected sleep, flexed containment, clustered care, procedural analgesia — with staff still delivering all hands-on care and the parent welcome but secondary. Family-centred care welcomes parents as partners with open visiting, kangaroo care, shared information, and a place on rounds, but staff still deliver most care and the parent remains an involved visitor. FiCare restructures the relationship so that parents are the primary caregivers for at least eight hours a day, with structured education, peer support, and presence on rounds, while the nurse shifts from carer to teacher and mentor. ^{[2] [4]}

b) Outline the core components of a FiCare programme as implemented in the O'Brien 2018 trial. (3 marks) The core components are: (i) parental presence at the cot-side for at least eight hours a day; (ii) a structured education programme of daily sessions over approximately four weeks covering feeding, safety, neurodevelopment, discharge readiness, and parent wellbeing; (iii) parents delivering hands-on care — feeds, nappies, observations, documentation, kangaroo care — under nursing mentorship; (iv) a parent peer-support group; and (v) parent participation on medical rounds and family-centred discharge planning. ^{[1] [2]}

c) State the primary and key secondary outcomes of the O'Brien 2018 multicentre cluster randomised trial and what they showed. (3 marks) The O'Brien 2018 trial randomised 26 tertiary NICUs across Canada, Australia, and New Zealand to FiCare or standard care. The primary outcome was weight-gain z-score change at day 21: −0.07 with FiCare versus −0.16 with standard care (p<0.0002), with higher average daily weight gain. Key secondary outcomes showed reduced parental stress and anxiety on the PSS:NICU and increased high-frequency exclusive breastmilk feeding at discharge, with no safety signal. ^[2]