Effects of family-centered care interventions on preterm infants and parents in neonatal intensive care units: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective: To review English and Chinese randomized controlled trials (RCTs) to determine the effects of family-centered care interventions on preterm infants’ and parental outcomes in Neonatal Intensive Care Units and to conduct a meta-analysis. Review method used: Systematic review and meta-analysis. Data sources: MEDLINE, CINAHL, EMBASE, PsycInfo, BNI, AMED and the Chinese databases CNKI and Wanfang were searched in April 2017 and updated in August 2018. Review methods: Only RCTs were included. Participants were preterm infants ≤ 37 weeks gestational age and parents. Interventions were related to family-centered care and outcome measures were infant and parent clinical outcomes. Included studies were assessed for risk of bias using Cochrane Manual 5.1.0. Meta-analyses used Mean Differences (MD), Standardized Mean Differences (SMD) or Odds Ratio (OR) followed by 95% Confidence Interval (CI). Heterogeneity was tested with Cochran’s Q chi-square, tau-squared and inconsistency index (I2). Results: Included were 19 studies (10 from English and 9 from Chinese databases); meta-analysis included 15 studies (7 English and 8 Chinese RCTs). Meta-analysis showed significant improvements in weight gain (7 studies: MD 4.57; 95%CI: 2.80;6.34; P<0.001; I2 94%); readmission (3 studies: OR=0.23; 95%CI: 0.10;0.52; P<0.001; I2=0%); parent satisfaction (5 studies: OR=11.20; 95%CI: 4.76;26.34; p<0.001; I2=0%); Skills of parents (4 studies: SMD=2.57; 95%CI: 2.19;2.96; P<0.001; I2=53%); Knowledge of parents (4 studies: SMD=2.74; 95%CI: 2.47;3.00; P<0.001; I2=0%); Parental anxiety at follow-up: (3 studies: SMD=-0.19; 95%CI: -0.28;-0.09; P<0.001; I2=0%); Parent depression at follow-up: (2 studies: SMD=0.37; 95%CI: -0.63;-0.12; P=0.004; I2=44%); Parental stress: (3 studies: MD=-0.20; 95%CI: -0.26;-0.13; P<0.001; I2=0%). No statistical differences were observed in neuro-behavioral-development (3 studies) and hospital-length-of-stay (7 studies). Conclusions: Family-centered care interventions can improve weight gain and readmission in preterm infants as well as parent satisfaction, knowledge and skills, and possibly long-term anxiety, depression and stress. Developing standardized outcome sets for testing family-centered care interventions is recommended.