Family-centred care for vulnerable newborns

There are approximately 6,500 newborn deaths every day in Bangladesh, amounting to 47% of all child deaths under the age of 5 years. Almost 75% of neonatal deaths occur during the first week of life, and about 1 million newborns die within the first 24 hours. The leading causes of neonatal death are premature birth, birth-related complications (birth asphyxia, birth trauma), neonatal infections and congenital anomalies.

The vulnerable newborns are treated in neonatal intensive care units (NICUs) for intensive monitoring. Sometimes they need to stay there for weeks or more, which leads to a prolonged separation from their parents. During this period, free parental access in NICU is usually restricted to prevent dissemination of hospital-acquired infections.

Nurses take care of an admitted newborn in an NICU. Besides providing necessary medical care, nurses also ensure feeding expressed milk, many times with feeding tubes, changing nappies, washing and dressing the babies. As parents are not actively engaged in core healthcare activities, sometimes there occurs a lack of information sharing, parental participation in treatment decisions, and ultimately failure of mutual respect between health professionals and the child's family.

To alleviate such an issue, family-centred care (FCC) is now encouraged. FCC means involving the family as much as possible in the routine care of their baby. It is an approach that prioritises the family as an integral part of the newborn's care and emphasises communication between healthcare providers and the family.

It recognises that the parents are not only mere attendants; rather, they are an important part of sick newborn care at hospitals. FCC also aims to decrease emotional trauma for families and empower them in their caregiving role for bringing positive outcomes for the newborn.

Healthcare professionals work with families as partners, sharing information, respecting their values, and collaborating on care decisions. This ensures open and honest communication with the parents and fosters trust between families and healthcare providers, which is crucial here.

It also helps the healthcare providers to get familiar with the family's culture, beliefs, and parenting practices. Families become more confident in their ability to care for their newborn, especially after discharge. FCC also helps the parents to develop confidence and skills in caring for their newborn.  FCC ensures increased breastfeeding success.

FCC impacts early childhood development by addressing the developmental needs of the small and sick newborn. It protects them from the damaging effects of separation during inpatient care, such as safeguarding sleep, promoting appropriate sensory interaction (i.e., smell, touch, sound), monitoring and managing pain and stress, and creating a healing environment. The parent's ability to adjust to preterm birth and the quality of early parent-infant relationships are suggested to be critical aspects that impact the development and acquisition of competencies later.

Key aspects related to neonatal FCC include the parents' presence in the ward and their participation in infants' daily care and decision-making processes.

For successful implementation of FCC in neonatal intensive care units, we have to ensure easy access for the parents in NICUs and their comfortable seating arrangements. Healthcare providers also need to be trained in FCC principles and practices.

Responsible and accountable acts from both the parents and healthcare professionals can bring better and sustainable healthcare outcomes for sick newborns. Family-centred care for sick newborns here is now a time-demanding strategy to practise.

The writers are the assistant professors of neonatology at the Institute of Child & Mother Health (ICMH), Matuail, Dhaka, and Chairman of the Department of Neonatology at the Bangladesh Medical University (BMU), Dhaka, respectively. Emails: [email protected], [email protected]