Keeping parents and their babies close – results of an international study on implementation, facilitators, and barriers in neonatal units


Family integrated care (FICare) is important for parent and infant health. A recent study gives an overview of current facilitators and barriers to parent-infant closeness and zero-separation in hospitals in 19 countries. The findings show that the separation of parents and their babies is very common. The study found four themes that could help explain the challenges that families and healthcare professionals encounter: Culture, Collaboration, Capacities and Coaching.

When mother and child are separated during their stay in the hospital, emotional and physical closeness is limited, and raises feelings of unpreparedness to go home, which can affect the parents’ or the baby’s health. Therefore, family integrated care (FICare) has received particular attention over the past years, alongside two of its core components; parent-infant closeness and zero-separation.

In Europe, little is known about the current state and application of FICare in neonatal intensive care units (NICUs). This knowledge gap encouraged a group of researchers, including the CROWN Study Group, to look into the facilitators and barriers to parent-infant closeness and zero-separation in 19 countries. Healthcare professionals representing 45 NICUs from different regions in Europe and Canada were interviewed during June–December 2018. The analysis showed that despite implementing FICare practices, such as parent participation in medical rounds or structured education sessions, parent-infant separation during care is very common (93%). Many healthcare professionals, however, were willing to facilitate parent-infant closeness. Still, they faced challenges, which can be divided into four main themes:

Culture was the overarching theme encompassing the others. It was defined as jointly held characteristics, values, thinking and behaviours about parents’ presence and participation in the unit. Culture also included the willingness of parents to be involved. This theme varied a lot across NICUs.

Collaboration (working together between and within different levels) was also a clear facilitator for FICare. Collaboration between staff from different disciplines and between parents and staff was essential to keep families close. Family-centred rounds were present 38% of the time.

Capacities were either seen as resources, which could be physical (e.g. equipment) or human (e.g. staffing), or as policies (e.g. guidelines). The existence and use, or the lack of Capacities, were decisive for them to act as either facilitators or barriers for FICare.

Coaching was the fourth theme and included education, knowledge transfer, and skills. Results showed that Coaching was implemented regularly for parents (36%) and healthcare professionals (49%). Nevertheless, there is a discrepancy between professionals’ training and what the reality of zero-separation after birth requires them to do. Additionally, less confidence from professionals in caring for babies or mothers meant more parent-infant separation.

Parent-infant separation, as it was found in this study, is not a consequence of the COVID-19 pandemic, as the interviews took place before pandemic-related restrictions were implemented in hospitals. The research group acknowledges that change within hospitals and units can be very challenging, specifically concerning hospital(care) culture. Nevertheless, the ‘four Cs’ –Culture, Collaboration, Capacities, and Coaching– are necessary strategies for zero-separation and parent-infant closeness, irrespective of an ongoing pandemic.

EFCNI is a part of the CROWN Study Group, and EFCNI’s chairwoman, Silke Mader, is one of the authors of this study.

Paper available at: Pediatric Investigation / John Wiley & Sons, Ltd

Full list of authors: Nicole R. van Veenendaal, Nanon H.M. Labrie, Silke Mader, Anne A. M. W. van Kempen, Sophie R. D. van der Schoor, Johannes B. van Goudoever, CROWN Study Group