BIRTH 41:3 September 2014

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LETTER Family-Centered Neonatal Intensive Care To the Editor: Family-centered care of normal, term infants has long been endorsed, stimulated initially by Klaus and Kennell’s groundbreaking work on the importance of mother–infant contact for attachment (1). Until recently, however, ill and preterm babies were hospitalized apart from their mothers in neonatal intensive care units, with parents visiting occasionally and never providing direct care for the infant. Parents were not considered capable of participating in the highly technical management of the infant. Caregivers resisted being “observed” by parents, and having to explain procedures undertaken, some of which may have appeared to be excessive, and may, indeed, have been excessive (2). Evidence suggested, however, that parents needed more contact with seriously ill infants. Separation of healthy newborn infants from mothers declined partly as a result of the Baby Friendly Hospital Initiative that advocated 24-hour rooming-in as a key to successful breastfeeding. This has not had any significant impact on the organization of neonatal intensive care units (2,3) and has not addressed a full-time role for parents in providing care for these infants (3). While singleroom family units are currently being introduced in intensive care units, these do not necessarily allow for increased parental care for babies (4). In 1979, in Tallinn (Estonia), mothers were—unusually—permitted to stay together with their newborns in a neonatal intensive care unit for 24 hours a day (5) and to give breastmilk to their baby/ies by breast or nasogastric tube from the first possible moment, resulting in enhanced neonatal outcomes. Mothers provided some of the medical care that was hitherto given by nurses. This new approach was called the Humane Neonatal Care Initiative (6,7) and, in recent years, as other family members have been included, as the Family-Centered or Integrated Neonatal Care Initiative. The premise of this approach is that neonatal intensive care be supportive of close family involvement in caring for the sick or preterm newborn from the earliest possible time, while minimizing unnecessary procedures and supporting breastfeeding and the use of human milk. In many countries, development of legislation in support of child health is based on the United Nations Convention on the Rights of the Child. A new petition,

initiated by the present authors, calls for this Convention to be amended to incorporate the concepts of Family-Centered Neonatal Intensive Care (8). Signed by hundreds of caregivers from multiple countries, it has been submitted to various United Nations organizations involved in child care. We ask that all neonatal intensive care departments support this petition by initiating changes that promote a family-centered model of neonatal intensive care within their own organizations, as well as nationally and internationally.

Acknowledgment We thank Lawrence Gartner, MD, Professor Emeritus, The University of Chicago, for reviewing the draft letter. Adik Levin, PhD Department of Neonatology Tallinn Children’s Hospital (Retired) Tallinn, Estonia Beverley Chalmers, DSc(Med), PhD Department of Obstetrics and Gynaecology University of Ottawa Ontario, Canada

References 1. Klaus M, Kennel J. Maternal-infant bonding: The impact of early separation or loss on family development. St. Louis, MO: Mosby; 1976. 2. Levin A. Where are you going, neonatal medicine? News and views from Estonia. Initiat Crit Care Nurs 1995;11:49–52. 3. Chalmers B. The baby friendly hospital initiative: Where next? BJOG 2004;111(3):198–199. 4. O’Brien B, Bracht M, Macdonnell 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. 5. Levin A. The mother-infant unit at Tallinn Children’s Hospital, Estonia: A truly baby-friendly unit. Birth 1994;21:39–44. 6. Chalmers B, Levin A. Humane Perinatal Care. Tallinn, Estonia: TEA Publishers, 2000. 7. Levin A. Humane neonatal care initiative: Viewpoint. Acta Paediatr 1999;88:353–355. 8. Levin A, Chalmers B. Strengthening Newborn Intensive Care: Petition to UN Committee for Child Rights, 2014. Accessed June 27, 2014. Available at: http://www.perinat.ee/materjal/UN_letter_ 4_20130829.doc.

Family-centered neonatal intensive care.

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