When Parents Join the Care Team, Babies May Go Home Sooner

What a large Canadian study of Family Integrated Care found for families of premature babies (Benzies et al., BMC Pediatrics 2020)

A big study across every special-care baby unit in one Canadian province found that when parents were trained and supported to become active members of their premature baby's care team, their babies went home about two and a half days earlier — and were no more likely to be readmitted to hospital or need an emergency visit afterward [1]. In other words, giving families a real role at the bedside didn't just feel good; it appeared to help babies reach the "ready for home" milestone faster, safely. This article explains what the researchers did, what they found, and what it means for families whose baby is in the NICU.

Why This Question Matters

Premature birth is common. Worldwide, about one in ten babies is born early, and most premature babies — roughly 85% — arrive only mildly to moderately early, between 32 and 36 weeks of pregnancy [2]. These babies usually don't need the most intensive equipment. Instead, they need time to grow, learn to feed, and keep themselves warm, and they are often cared for in what's called a Level II or "special care" nursery rather than the highest-intensity unit [3]. For these families, the last stretch before discharge is mostly about one thing: parents becoming confident enough to care for their baby at home.

That confidence is exactly what a NICU stay can undermine. Having a baby arrive early is frightening and disorienting. Parents often feel anxious, helpless, and pushed to the sidelines while doctors and nurses focus on medical care — and being separated from their baby in this way can strain the early bond between parent and child [4]. For years, hospitals tried to address this with "family-centred care," which welcomed parents but still left them mostly as visitors. A newer approach, called Family Integrated Care, goes much further: it treats parents as core members of the care team who do hands-on caregiving, speak up during medical rounds, and help make decisions.

What Came Before This Study

Family Integrated Care was first tested carefully in high-intensity units caring for the sickest, most premature babies. A large international study across 26 of those units showed real benefits — babies gained weight better and breastfed more, and parents felt less stressed — but, interestingly, it did not shorten how long babies stayed in the hospital [5]. An even earlier, smaller pilot in a single Canadian unit had pointed in the same encouraging direction on weight gain, breastfeeding, and lower stress [6]. That left an important gap. In the higher-intensity units, how long a baby stays depends mostly on serious medical issues that parents can't change. But in special-care nurseries, discharge depends largely on feeding and parent readiness — the very things a parent-empowerment program is built to improve. Researchers wondered: would Family Integrated Care actually get babies home sooner if it were used where readiness, not illness, is the hold-up? Earlier attempts at family-centred programs had produced mixed results on length of stay, partly because they varied so much from place to place [7]. This study set out to give a clearer answer.

What the Researchers Did

The team worked with all ten special-care nurseries in the province of Alberta, Canada. They randomly assigned five units to use a made-for-Level-II version of the program, called Alberta FICare™, and five to continue their usual care [1]. Assigning whole units — rather than individual babies — kept the two approaches from blurring together. The study included mothers and their babies (single babies and twins) born between 32 and nearly 35 weeks. In the end, about 353 babies were cared for under the new program and 365 under usual care.

The Alberta FICare™ program had three main parts. The first was better communication: nurses and doctors actively invited parents to share updates about their baby during rounds and to help plan care, and they gave parents encouraging, specific feedback. The second was education: a step-by-step learning path, bedside teaching, group classes, and a phone app helped parents build skills and check them off as they went. The third was support: screening mothers for postpartum depression and connecting them to help, plus "Family Mentors" — parents who had been through the NICU themselves — offering peer support [1]. To make it easier for parents to be present, the program also gave families a parking pass and a journal to track their baby's progress, and asked parents to spend at least six hours a day with their baby. These practical touches matter more than they might seem: the cost and hassle of parking, or not feeling genuinely welcome at the bedside, are the kinds of everyday barriers that quietly keep parents away during the hours when they could be learning to care for their baby.

The hospitals that used the program also invested in making it real. Specially trained nurses, called "Super-Users," taught the rest of the staff and kept the approach going with refresher sessions, and the researchers checked regularly to see how faithfully each unit was actually following the program. That kind of follow-through turned out to be important — one unit that had trouble with staffing and physician coverage struggled to deliver the program fully, which is a useful reminder that a good idea only helps if a hospital has the people and support to carry it out consistently.

What They Found

The main finding was about time at home. Once the researchers fairly accounted for differences between hospitals and babies, babies in the Alberta FICare™ program stayed about 17.6 days on average, compared with about 20.2 days in usual care — a difference of 2.55 days sooner to home (with a range that the statistics put roughly between about half a day and four and a half days) [1]. Two and a half days may not sound dramatic, but for a family it means an earlier reunion at home, and for a hospital it means a bed freed for the next baby who needs it. It's also worth knowing that the difference only became clear once the researchers carefully accounted for the fact that different hospitals and different babies start from different places; a simple side-by-side comparison, before that adjustment, did not show a clear difference. That is a normal and honest part of how careful studies work, not a sign that the finding is shaky.

Just as reassuring is what didn't happen. Going home sooner did not lead to more problems. Babies in the program were just as unlikely to be readmitted to the hospital (about 6% in both groups) or to need an emergency department visit (about 24% versus 26%) in the two months after discharge [1]. Breastfeeding at discharge was high in both groups — around 95% of babies were getting at least some breastmilk. The study also measured mothers' anxiety, depression, stress, and confidence at discharge; these all leaned slightly in the program's favour, but the differences were small enough that they could have been due to chance.

What It Means for Your Family

If your baby is in a special-care nursery, the most useful takeaway is empowering: your involvement genuinely matters. Being present, learning hands-on care, asking questions on rounds, and taking on more of your baby's daily care as you gain confidence are not just comforting rituals — in this study, that kind of active participation was linked to babies going home earlier, without any added risk [1]. It's worth remembering a few honest limits, too. The program worked as a whole package, so no one can say which single part mattered most; the study was done in one province with one kind of health system, so results might differ elsewhere; and it focused on moderately premature babies, not the most fragile ones. The study also didn't prove that the program lifted mothers' mood or confidence by the time of discharge — though researchers suspect those benefits may simply show up later, once families are managing at home, a pattern seen in other work on parent programs [8] and on discharge planning [9].

What Researchers Are Working On Next

The clearest next step is to repeat the study in more hospitals and different health systems, to confirm the benefit holds up widely and to look more closely at effects on parents. Researchers also want to figure out which ingredients of the program do the heavy lifting — the communication changes, the education, the peer support, or simply making it easier for parents to be there — so that even units with limited resources can offer a streamlined, effective version. A core idea running through all of it is that clear, respectful communication between families and staff, with well-defined roles for each, is what allows parents to safely take on more care [10]. For now, this study offers families and hospitals something hopeful and practical: when parents are truly brought onto the team, everyone — including the baby — may benefit.

References

  1. Benzies KM, Aziz K, Shah V, et al. Effectiveness of Alberta Family Integrated Care on infant length of stay in level II neonatal intensive care units: a cluster randomized controlled trial. BMC Pediatr. 2020;20(1):535. doi:10.1186/s12887-020-02438-6 ↩
  2. Chawanpaiboon S, Vogel JP, Moller A-B, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019;7(1):e37–e46. doi:10.1016/S2214-109X(18)30451-030451-0) ↩
  3. Committee on Fetus and Newborn. Levels of neonatal care. Pediatrics. 2012;130(3):587–597. doi:10.1542/peds.2012-1999 ↩
  4. Flacking R, Lehtonen L, Thomson G, et al. Closeness and separation in neonatal intensive care. Acta Paediatr. 2012;101(10):1032–1037. doi:10.1111/j.1651-2227.2012.02787.x ↩
  5. 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;2(4):245–254. doi:10.1016/S2352-4642(18)30039-730039-7) ↩
  6. O'Brien K, Bracht M, Macdonell K, et al. A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit. BMC Pregnancy Childbirth. 2013;13(Suppl 1):S12. doi:10.1186/1471-2393-13-S1-S12 ↩
  7. Ding X, Zhu L, Zhang R, Wang L, Wang T-T, Latour JM. Effects of family-centred care interventions on preterm infants and parents in neonatal intensive care units: a systematic review and meta-analysis of randomised controlled trials. Aust Crit Care. 2019;32(1):63–75. doi:10.1016/j.aucc.2018.10.007 ↩
  8. Puthussery S, Chutiyami M, Tseng P-C, Kilby L, Kapadia J. Effectiveness of early intervention programs for parents of preterm infants: a meta-review of systematic reviews. BMC Pediatr. 2018;18(1):223. doi:10.1186/s12887-018-1205-9 ↩
  9. Ingram JC, Powell JE, Blair PS, et al. Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England. BMJ Open. 2016;6(3):e010752. doi:10.1136/bmjopen-2015-010752 ↩
  10. Benzies KM. Relational communication strategies to support family-centered neonatal intensive care. J Perinat Neonatal Nurs. 2016;30(3):233–236. doi:10.1097/JPN.0000000000000195 ↩