By Sandy Hemphill, Contributing Writer, BabyMed
When babies are born early, they face a monumental list of health challenges that prevents them from going home when their mothers leave the hospital. Parents may be confident their preemies are in good hands in the neonatal intensive care unit (NICU) but feelings of helplessness and fear are inevitable. Even when discharged from hospital care, babies born prematurely are still quite fragile and parents may worry they won't do things right. A study from the University of Bristol in England found that including parents in the baby's discharge plan and training parents to care for their newborns at home boosts parent confidence and makes for healthier babies.
The British researchers call their parent-training program Train-to-Home. The program provides NICU-to-home transition training for the parents and uses a brightly colored train with five cars to mark progress.
Each of the five cars represents a physical challenge prematurity brings -- breathing, feeding, growth, sleeping, and temperature. As the baby achieves stability in each of these markers for health, the parents have a visual indicator that progress is being made as the baby moves from NICU to high-dependency and special-care hospital units and, finally, to home.
The Train-to-Home intervention involves more than a cheerful train, though. It includes the baby's anticipated discharge date and charts that help parents understand what is happening with their baby's progress and coaches them on what questions to ask along the journey.
Success of the Train-to-Home intervention was measured in a before-and-after study of babies born during the 11 months before the program was implemented and the 11 months after it began. Babies in the study were all being cared for at one of four local neonatal units in South West England. Each had been born at 27 to 33 weeks gestation.
Success was measured using three criteria:
- Perceived Maternal Parenting Self-Efficacy (PMP S-E) scores.
- Baby's length of stay (LOS) in hospital care.
- Utilization of health care in the 8 weeks following the baby's hospital discharge.
Parents in the "after" group, getting the Train-to-Home intervention, reported a greater degree of understanding what was happening with their baby and felt more prepared to take the baby home than the "before" group. There was no change, however, in the before or after groups' PMP S-E scores but:
- After-discharge visits to emergency care centers dropped from 31 to 20 once the intervention became hospital policy.
- After-discharge healthcare costs dropped from an average of $5,000 (US dollars) to $3,000.
There was no reduction in LOS before or after the program began but more than 50% of all babies, before and after, were discharged more than three weeks before their estimated delivery date had they been carried to full term.
Even though parents continued to report trepidation and anxiety about caring for their preemie after hospital discharge, the program is considered a success due to its ability to reduce the number of emergency visits after discharge and healthcare cost reductions.
In the US, the Agency for Healthcare Research and Quality has developed a family information packet called "Transitioning Newborns fro NICU to Home" that describes many medical issues a parent might face including what symptoms to beware of, when to seek medical help, and how to care for a newborn on a daily basis. It even offers tips on getting the baby included on the family healthcare plan, including the note to add the baby within 30 days.
Sources:
Ingram, Jenny C, et al. "Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England."BMJ Open. BMJ Publishing Group Ltd., 10 Mar. 2016. Web. 17 Mar. 2016.
Purdy, IB, JW Craig, and P Zeanah. "NICU discharge planning and beyond: recommendations for parent psychosocial support."PMC. Journal of Perinatology / Nature Publishing Group, Dec. 2015. US National Library of Medicine / National Institutes of Health. Web. 17 Mar. 2016.
"Transitioning Newborns from NICU to Home."Agency for Healthcare Research and Quality. US Department of Health and Human Services, n.d. Web. 17 Mar. 2016.