World Journal of Pediatrics

, Volume 13, Issue 2, pp 144–151 | Cite as

Breaking down barriers: enabling care-by-parent in neonatal intensive care units in China

  • Xiao-Ying Li
  • Shoo Lee
  • Hua-Feng Yu
  • Xiang Y. Ye
  • Ruth Warre
  • Xiang-Hong Liu
  • Jian-Hong Liu
Original Article



Denying parents access to their infant in the Neonatal Intensive Care Unit (NICU) is a standard practice in most hospitals across China. Visitation is not usually permitted or may be strictly limited, and NICU care for most neonates is provided by health-care professionals with little participation of the parents. An exception to this rule is the level 2 “Room-In” ward in Qilu Children’s Hospital, Shandong University, where parents have 24-hour access to their infants and participate in providing care.


This retrospective cohort study compared the outcomes of infants who were admitted to the NICU and remained there throughout their stay (NICU-NICU group, n=428), admitted to the NICU and then transferred to the Room-In ward (NICU-RIn group, n=1018), or admitted straight to the Room-In ward (RIn only group, n=629).


There were no significant differences in the rates of nosocomial infection, bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity between the NICU-NICU and NICU-RIn groups. The rate of necrotizing enterocolitis was significantly lower in the NICU-RIn group (P=0.04), while weight gain and duration of hospital stay were significantly higher (both P<0.001). Rates of adverse outcomes were lower in RIn-only infants due to their low severity of illness on admission.


Allowing parents access to their infant in the NICU is feasible and safe in China, and may result in improvements in infant outcomes. Further studies are required to generate stronger evidence that can inform changes to neonatal care in China.

Key words

care-by-parent family-centered care infant newborn neonatal intensive care unit parental involvement 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.



We would like to thank the staff of the Canadian Neonatal Network Coordinating Centre, Toronto, Canada, for their assistance with the database and developing a data collection procedure. We would also like to thank the medical team in the Neonatology Department, Qilu Children’s Hospital Shandong University, Jinan, China for data collection.


  1. 1.
    American Academy of Pediatrics. Policy statement: Family-centered care and the pediatrician’s role. Pediatrics 2003;112:691–697.CrossRefGoogle Scholar
  2. 2.
    Gooding JS, Cooper LG, Blaine AI, Franck LS, Howse JL, Berns SD. Family support and family-centered care in the neonatal intensive care unit: origins, advances, impact. Semin Perinatol 2011;35:20–28.CrossRefPubMedGoogle Scholar
  3. 3.
    Ramanathan K, Paul VK, Deorari AK, Taneja U, George G. Kangaroo Mother Care in very low birth weight infants. Indian J Pediatr 2001;68:1019–1023.CrossRefPubMedGoogle Scholar
  4. 4.
    Suman RP, Udani R, Nanavati R. Kangaroo mother care for low birth weight infants: a randomized controlled trial. Indian Pediatr 2008;45:17–23.PubMedGoogle Scholar
  5. 5.
    Tessier R, Charpak N, Giron M, Cristo M, de Calume ZF, Ruiz-Pelaez JG. Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study. Acta Paediatr 2009;98:1444–1450.CrossRefPubMedGoogle Scholar
  6. 6.
    Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, et al. Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics 2006;118:e1414–e1427.CrossRefPubMedGoogle Scholar
  7. 7.
    Newnham CA, Milgrom J, Skouteris H. Effectiveness of a modified Mother-Infant Transaction Program on outcomes for preterm infants from 3 to 24 months of age. Infant Behav Dev 2009;32:17–26.CrossRefPubMedGoogle Scholar
  8. 8.
    O’Brien K, Bracht M, Macdonell K, McBride T, Robson K, O’Leary L, et al. A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit. BMC Pregnancy Childbirth 2013;13:S12.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Levin A. The Mother-Infant unit at Tallinn Children’s Hospital, Estonia: a truly baby-friendly unit. Birth 1994;21:39–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Ortenstrand A, Westrup B, Brostrom EB, Sarman I, Akerstrom S, Brune T, et al. The Stockholm Neonatal Family Centered Care Study: effects on length of stay and infant morbidity. Pediatrics 2010;125:e278–e285.CrossRefPubMedGoogle Scholar
  11. 11.
    Montirosso R, Del PA, Bellu R, Tronick E, Borgatti R. Level of NICU quality of developmental care and neurobehavioral performance in very preterm infants. Pediatrics 2012;129:e1129–e1137.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Erdeve O, Arsan S, Yigit S, Armangil D, Atasay B, Korkmaz A. The impact of individual room on rehospitalization and health service utilization in preterms after discharge. Acta Paediatr 2008;97:1351–1357.CrossRefPubMedGoogle Scholar
  13. 13.
    Bhutta ZA, Khan I, Salat S, Raza F, Ara H. Reducing length of stay in hospital for very low birthweight infants by involving mothers in a stepdown unit: an experience from Karachi (Pakistan). BMJ 2004;329:1151–1155.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Flacking R, Lehtonen L, Thomson G, Axelin A, Ahlqvist S, Moran VH, et al. Closeness and separation in neonatal intensive care. Acta Paediatr 2012;101:1032–1037.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Liu N, Mao L, Sun X, Liu L, Chen B, Ding Q. Postpartum practices of puerperal women and their influencing factors in three regions of Hubei, China. BMC Public Health 2006;6:274.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Zhang X, Lee SY, Chen J, Liu H. Factors influencing implementation of developmental care among NICU nurses in China. Clin Nurs Res. 2016;25:238–253.CrossRefPubMedGoogle Scholar
  17. 17.
    American Academy of Pediatrics, Committee on Fetus and Newborn. Policy Statement: Levels of neonatal care. Pediatrics 2012;130:587–597.CrossRefGoogle Scholar
  18. 18.
    Lee SK, McMillan DD, Ohlsson A, Pendray M, Synnes A, Whyte R, et al. Variations in practice and outcomes in the Canadian NICU network: 1996-1997. Pediatrics 2000;106:1070–1079.CrossRefPubMedGoogle Scholar
  19. 19.
    Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49:1373–1379.CrossRefPubMedGoogle Scholar
  20. 20.
    Cai XD, Cao Y, Chen C, Yang Y, Wang CQ, Zhang L, et al. Investigation of nosocomial infection in the neonatal intensive care unit. Zhongguo Dang Dai Er Ke Za Zhi 2010;12:81–84. [In Chinese]PubMedGoogle Scholar
  21. 21.
    Xu XF, Ma XL, Chen Z, Shi LP, Du LZ. Clinical characteristics of nosocomial infections in neonatal intensive care unit in eastern China. J Perinat Med 2010;38:431–437.CrossRefPubMedGoogle Scholar
  22. 22.
    Xu Y, Zhang LJ, Ge HY, Wang DH. Clinical analysis of nosocomial infection in neonatal intensive care units. Zhonghua Er Ke Za Zhi 2007;45:437–441. [In Chinese]PubMedGoogle Scholar
  23. 23.
    Lam BC, Lee J, Lau YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics 2004;114:e565–e571.CrossRefPubMedGoogle Scholar
  24. 24.
    Mai JY, Dong L, Lin ZL, Chen SQ. Investigation and analysis of nosocomial infection in neonates. Zhonghua Er Ke Za Zhi 2011;49:915–920. [In Chinese]PubMedGoogle Scholar
  25. 25.
    Wu J, Wu BQ, Huang JJ, Luo L, Tang Y. Risk factors and pathogen distribution in premature infants with nosocomial sepsis. Zhongguo Dang Dai Er Ke Za Zhi 2012;14:93–96. [In Chinese]PubMedGoogle Scholar
  26. 26.
    Wang J, Guo QL, Zhao ZZ, Yang Y. Effects of parental participation nursing model on premature infants. Nurs J Chin PLA 2013;30:20–23. [In Chinese]Google Scholar
  27. 27.
    He PP, Xu LH, Shen N, Lou JH. Parents’ perception of familycentered nursing care. Zhonghua Hu Li Za Zhi 2005;40:885. [In Chinese]Google Scholar
  28. 28.
    Zhang X, Feng SJ, Han DR, Wu XH, Chen JL. The level and influencing factors of development supporting care among NICU nurses. Zhonghua Hu Li Za Zhi 2009;47:828–829. [In Chinese]Google Scholar
  29. 29.
    UNICEF. The Baby-Friendly Hospital Initiative [Online source]. 2015. Avaliable from: (accessed March 30, 2015)Google Scholar
  30. 30.
    Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skinto-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry 2014;75:56–64.CrossRefPubMedGoogle Scholar
  31. 31.
    Latva R, Lehtonen L, Salmelin RK, Tamminen T. Visiting less than every day: a marker for later behavioral problems in Finnish preterm infants. Arch Pediatr Adolesc Med 2004;158:1153–1157.CrossRefPubMedGoogle Scholar
  32. 32.
    Melnyk BM, Alpert-Gillis L, Feinstein NF, Fairbanks E, Schultz-Czarniak J, Hust D, et al. Improving cognitive development of low-birth-weight premature infants with the COPE program: a pilot study of the benefit of early NICU intervention with mothers. Res Nurs Health 2001;24:373–389.CrossRefPubMedGoogle Scholar
  33. 33.
    Nordhov SM, Ronning JA, Dahl LB, Ulvund SE, Tunby J, Kaaresen PI. Early intervention improves cognitive outcomes for preterm infants: randomized controlled trial. Pediatrics 2010;126:e1088–e1094.CrossRefPubMedGoogle Scholar
  34. 34.
    Peters KL, Rosychuk RJ, Hendson L, Cote JJ, McPherson C, Tyebkhan JM. Improvement of short-and long-term outcomes for very low birth weight infants: Edmonton NIDCAP trial. Pediatrics 2009;124:1009–1020.CrossRefPubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Xiao-Ying Li
    • 1
  • Shoo Lee
    • 2
    • 3
  • Hua-Feng Yu
    • 1
  • Xiang Y. Ye
    • 2
  • Ruth Warre
    • 2
  • Xiang-Hong Liu
    • 1
  • Jian-Hong Liu
    • 1
    • 4
  1. 1.Neonatalogy DepartmentQilu Children’s Hospital Shandong UniversityJinanChina
  2. 2.Maternal-Infant Care Research CentreMount Sinai HospitalTorontoCanada
  3. 3.Department of PediatricsUniversity of TorontoTorontoCanada
  4. 4.Jinan, ShandongChina

Personalised recommendations