Clinical practice guidelines for involving mothers in high-risk neonate care at neonatal intensive care unit in low and middle-income countries: a discussion paper
AbstractMaternal involvement in neonatal care has been shown to significantly improve clinical outcomes for high-risk neonates and promote parental well-being. However, implementing these practices in neonatal intensive care units (NICUs) in low and middle-income countries (LMICs) presents unique challenges due to resource constraints, cultural differences, infrastructural and workforce limitations. This discussion paper describes the strategies and considerations for effectively involving mothers in the care of high-risk neonates in NICUs in LMICs. Through a review of existing literature, case studies, and practical recommendations, this paper aims to provide a comprehensive framework for the successful implementation of parental involvement in neonatal care.
Keywords: clinical practice guidelines; mothers; newborns; high-risk neonate care; neonatal intensive care units; low and middle-income countries; clinical outcomes
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
Acknowledgment. Authors appreciate the technical assistance and resources provided by the Siksha ‘O’ Anusandhan University, Bhubaneshwar, India.
For citation: Siva N., Praharaj M., Tripathy P. Clinical practice guidelines for involving mothers in high-risk neonate care at neonatal intensive care unit in low and middle-income countries: a discussion paper. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2024; 12 (3): 86–9. DOI: https://doi.org/10.33029/2308-2402-2024-12-3-86-89
References
1. Siva N., Phagdol T., Nayak B.S., Glane Mathias E., Lewis L.E.S., Velayudhan B., et al. Stress and stressors experienced by the parents of high-risk neonates admitted in neonatal intensive care unit: systematic review and meta-analysis evidence available from India. Stress Health J Int Soc Investig Stress. 2024; 40 (2): e3301. DOI: https://doi.org/10.1002/smi.3301
2. Siva N., Nayak B.S., Lewis L.E.S., Velayudhan B., Shenoy R.P., Phaneendra M., et al. Randomized controlled trial on the effect of the neonatal nurse navigator program on maternal stress and neonatal cortisol levels. J Obstet Gynecol Neonatal Nurs. 2024; 53 (2): 185–96.
3. Zeraati H., Nasimi F., Shahinfar J., Milan Delaiee M., Momenizadeh A., Barfidokht A. The effect of family-centered care program on maternal attachment in mothers of premature infants. J Babol Univ Med Sci. 2017; 19 (6): 22–7.
4. Hoxha K., Hung Y.W., Irwin B.R., Grépin K.A. Understanding the challenges associated with the use of data from routine health information systems in low- and middle-income countries: a systematic review. Health Inf Manag J. 2022; 51 (3): 135–48. DOI: https://doi.org/10.1177/1833358320928729
5. Puchalski Ritchie L.M., Khan S., Moore J.E., Timmings C., van Lettow M., Vogel J.P., et al. Low- and middle-income countries face many common barriers to implementation of maternal health evidence products. J Clin Epidemiol. 2016; 76: 229–37.
6. Siva N., Nayak B.S., Lewis L.E.S., Velayudhan B., Phagdol T., Sathish Y., et al. Involvement of mothers in high-risk neonatal care: a capacity building program for neonatal nurses. J Neonatal Nurs. 2023; 29 (1): 91–6.
7. Rodrigo R., Amir L.H., Forster D.A. Parents’ views on prolonged maternal hospital stay with sick newborn infants in a tertiary neonatal unit in Sri Lanka. Adv Neonatal Care. 2024; 24 (2): 162-71. DOI: https://doi.org/10.1097/ANC.0000000000001148
8. Reiter A., De Meulemeester J., Kenya-Mugisha N., Tagoola A., Kabajaasi O., Wiens M.O., et al. Parental participation in the care of hospitalized neonates in low- and middle-income countries: a systematic review and meta-analysis. Front Pediatr. 2022; 10: 987228. DOI: https://doi.org/10.3389/fped.2022.987228
9. Gómez-Cantarino S., García-Valdivieso I., Moncunill-Martínez E., Yáñez-Araque B., Ugarte Gurrutxaga M.I. Developing a family-centered care model in the neonatal intensive care unit (NICU): a new vision to manage healthcare. Int J Environ Res Public Health. 2020; 17 (19): 7197. DOI: https://doi.org/10.3390/ijerph17197197
10. Maria A., Litch J.A., Stepanchak M., Sarin E., Wadhwa R., Kumar H. Assessment of feasibility and acceptability of family-centered care implemented at a neonatal intensive care unit in India. BMC Pediatr. 2021; 21 (1): 171. DOI: https://doi.org/10.1186/s12887-021-02644-w
11. Oluoch D., Hinton L., English M., Irimu G., Onyango T., Jones C.O.H. Mothers’ involvement in providing care for their hospitalised sick newborns in Kenya: a focused ethnographic account. BMC Pregnancy Childbirth. 2023; 23 (1): 389. DOI: https://doi.org/10.1186/s12884-023-05686-3
12. Deorari A.K., Kumar P., Chawla D., Thukral A., Goel S., Bajaj R., et al. Improving the quality of health care in special neonatal care units of India: a before and after intervention study. Glob Health Sci Pract. 2022; 10 (5): e2200085. DOI: https://doi.org/10.9745/GHSP-D-22-00085
13. Jafari Z., Kermanshahi S.M.K., Vanaki Z., Mosayebi Z. Parental barriers to implementing family-centred care in a neonatal intensive care unit in Islamic Republic of Iran. East Mediterr Health J. 2024; 30 (5): 356–62.
14. Nayak B.S., Lewis L.E., Margaret B., Bhat Y.R., D’Almeida J., Phagdol T. Randomized controlled trial on effectiveness of mHealth (mobile/smartphone) based Preterm Home Care Program on developmental outcomes of preterms: study protocol. J Adv Nurs. 2019; 75 (2): 452–60. DOI: https://doi.org/10.1111/jan.13879
15. Siva N., Nayak B.S., Lewis L.E.S., Velayudhan B., Bharadwaj S.K., Noronha J.A. Development of high-risk neonatal nurse navigator program. J Neonatal Nurs. 2023; 29 (6): 825–31. DOI: https://doi.org/10.1016/j.jnn.2023.02.014
16. WHO. Mother Newborn Care Unit: an innovation in care of small and sick newborns [Electronic resource]. 2022. URL: https://www.who.int/southeastasia/news/feature-stories/detail/mother-newborn-care-unit (date of access July 6, 2024).
17. Grewal G., Fuller S.S., Rababeh A., Maina M., English M., Paton C., et al. Scoping review of interventions to improve continuity of postdischarge care for newborns in LMICs. BMJ Glob Health. 2024; 9 (1): e012894. DOI: https://doi.org/10.1136/bmjgh-2023-012894
18. Lassi Z.S., Kumar R., Bhutta Z.A. Community-based care to improve maternal, newborn, and child health. In: Black R.E., Laxminarayan R., Temmerman M., Walker N. (eds). Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities. 3rd ed. Vol. 2. Washington, DC: World Bank. DOI: https://doi.org/10.1596/978-1-4648-0348-2
19. Patterson J., Worku B., Jones D., Clary A., Ramaswamy R., Bose C. Ethiopian Pediatric Society Quality Improvement Initiative: a pragmatic approach to facility-based quality improvement in low-resource settings. BMJ Open Qual. 2021; 10 (1): e000927.
20. Ferreira A., Ferretti E., Curtis K., Joly C., Sivanthan M., Major N., et al. Parents’ views to strengthen partnerships in newborn intensive care. Front Pediatr. 2021; 9: 721835.
21. Mason L., Dellicour S., Ter Kuile F., Ouma P., Phillips-Howard P., Were F., et al. Barriers and facilitators to antenatal and delivery care in western Kenya: a qualitative study. BMC Pregnancy Childbirth. 2015; 15 (1): 26. DOI: https://doi.org/10.1186/s12884-015-0453-z
22. Mirlashari J., Brown H., Fomani F.K., de Salaberry J., Zadeh T.K., Khoshkhou F. The challenges of implementing family-centered care in NICU from the perspectives of physicians and nurses. J Pediatr Nurs. 2020; 50: e91–8.
23. National Academies of Sciences, Engineering, and Medicine, Board on Children, Youth, and Families, Committee on Supporting the Parents of Young Children, Division of Behavioral and Social Sciences and Education; Breiner H., Ford M., et al. Parenting knowledge, attitudes, and practices. In: Parenting Matters: Supporting Parents of Children Ages 0–8. National Academies Press (US), 2016. URL: https://www.ncbi.nlm.nih.gov/books/NBK402020/ (date of access July 6, 2024).
24. Hoeben H., Alferink M.T., van Kempen A.A.M.W., van Goudoever J.B., van Veenendaal N.R., van der Schoor S.R.D. Collaborating to Improve Neonatal Care: ParentAl Participation on the NEonatal Ward – Study Protocol of the neoPARTNER Study. Children. 2023; 10 (9): 1482.
25. Boelsma F., Bektas G., Wesdorp C.L., Seidell J.C., Dijkstra S.C. The perspectives of parents and healthcare professionals towards parental needs and support from healthcare professionals during the first two years of children’s lives. Int J Qual Stud Health Well-Being. 2021; 16 (1): 1966874.
26. Eden C.A., Chisom O.N., Adeniyi I.S. Parent and community involvement in education: strengthening partnerships for social improvement. Int J Appl Res Soc Sci 2024; 6 (3): 372–82. DOI: https://doi.org/10.51594/ijarss.v6i3.894
27. Chuo J., Makkar A., Machut K., Zenge J., Jagarapu J., Azzuqa A., et al. Telemedicine across the continuum of neonatal-perinatal care. Semin Fetal Neonatal Med. 2022; 27 (5): 101398. DOI: https://doi.org/10.1016/j.siny.2022.101398