This article is part of the supplement: Preterm Birth - Interdisciplinary research from the Preterm Birth and Healthy Outcomes Team (PreHOT)

Open Access Research

A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit

Karel O’Brien12*, Marianne Bracht2, Kristy Macdonell2, Tammy McBride2, Kate Robson2, Lori O’Leary2, Kristen Christie2, Mary Galarza2, Tenzin Dicky2, Adik Levin3 and Shoo K Lee24

Author affiliations

1 Department of Paediatrics, University of Toronto, Toronto, M5G 1X5, Canada

2 Neonatal Intensive Care Unit, Mount Sinai Hospital, Toronto, M5G 1X5, Canada

3 Formerly at Newborn and Premature Children’s Department, Tallinn Children’s Hospital, Tallinn, Estonia

4 Departments of Paediatrics, Obstetrics & Gynaecology, and Public Health, University of Toronto, Toronto, M5G 1X5, Canada

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Citation and License

BMC Pregnancy and Childbirth 2013, 13(Suppl 1):S12  doi:10.1186/1471-2393-13-S1-S12

Published: 31 January 2013



We have developed a Family Integrated Care (FIC) model for use in a neonatal intensive care unit (NICU) where parents provide most of the care for their infant, while nurses teach and counsel parents. The objective of this pilot prospective cohort analytic study was to explore the feasibility, safety, and potential outcomes of implementing this model in a Canadian NICU.


Infants born ≤35 weeks gestation, receiving continuous positive airway pressure or less respiratory support, with a primary caregiver willing and able to spend ≥8 hours a day with their infant were eligible. Families attended daily education sessions and were mentored at the bedside by nurses. The primary outcome was weight gain, as measured by change in z-score for weight 21 days after enrolment. For each enrolled infant, we identified two matched controls from the previous year’s clinical database. Differences in weight gain between the two groups were analyzed using a linear mixed effects multivariable regression model. We also measured parental stress levels using the Parental Stress Survey: NICU, and interviewed parents and nurses regarding their experiences with FIC.


This study included 42 mothers and their infants. Of the enrolled infants, matched control data were available for 31 who completed the study. The rate of change in weight gain was significantly higher in FIC infants compared with control infants (p < 0.05). There was also a significant increase in the incidence of breastfeeding at discharge (82.1 vs. 45.5%, p < 0.05). The mean Parental Stress Survey: NICU score for FIC mothers was 3.06 ± 0.12 at enrolment, which decreased significantly to 2.30 ± 0.13 at discharge (p < 0.05). Feedback from the parents and nurses indicated that FIC was feasible and appropriately implemented.


This study suggests that the FIC model is feasible and safe in a Canadian healthcare setting and results in improved weight gain among preterm infants. In addition, this innovation has the potential to improve other short and long-term infant and family outcomes. A multi-centre randomized controlled trial is needed to further evaluate the efficacy of FIC in the Canadian context.