Ryo Itoshima’s doctoral dissertation studied two family-centred care interventions and their effects on collaboration between staff and parents, physical closeness between parents and baby, and baby recovery in neonatal intensive care.
Imagine if your newborn baby needs special care or treatment in hospital. Should the baby be treated by healthcare staff away from the parents? No. Because parents are one of the essential and most important components of neonatal care. However, integrating parents into neonatal care is still a big challenge.
The doctoral dissertation of Doctoral Researcher Ryo Itoshima focuses on whether healthcare staff education and optimisation in architecture and care systems improve staff–parent collaboration, parent–baby closeness, and ultimately affect babies positively.
Family-centered neonatal care is significant, but the challenge is how to promote it
About 10% of newborns need admission to neonatal intensive care units (NICUs) to receive essential care and treatment. However, admission to NICUs may cause parent–baby separation and expose the babies to environments that could harm their development. There is a need for initiatives to promote parent–baby closeness and help the babies’ recovery in collaboration with parents, which is called family-centered care.
“Family-centered care in NICUs is beneficial for the health and development of babies and the well-being of the parents. This is clear from previous evidence,” says Itoshima.
Despite the importance of family-centered care, it is a challenge to change clinical practices in NICUs. Although many interventions have aimed to facilitate family-centered care in NICUs, the evidence on these interventions is still not sufficient. It remains unclear whether such interventions promote parent–baby closeness and collaboration with parents, and help babies’ recovery.
Ryo Itoshima’s project provided new knowledge showing that parent–baby closeness, staff–parent collaboration, and babies’ recovery can be promoted by two family-centered care interventions, namely the Close Collaboration with Parents and the Couplet Care Model.
Close Collaboration with Parents intervention improved staff–parent collaboration and promoted recovery of preterm babies
The Close Collaboration with Parents intervention comprises educational training for neonatal health care staff. It is unique in that it specifically focuses on staff–parent communication to promote collaboration with parents and aims to train all healthcare staff of the NICU. The intervention has been developed in Turku University Hospital. So far, about 30 NICUs from 9 countries have implemented it or started the implementation.
Itoshima analysed responses from about 400 families and 200 staff members in Estonia. The collaboration between healthcare staff and parents improved after the Close Collaboration with Parents intervention. The improvement was confirmed in both the parents’ and the staff’s evaluation. The effect was greater when a higher proportion of the staff completed the training.
Itoshima also analysed register data on over 14,000 preterm babies born in Finland between 2006 and 2020.
“To our knowledge, this was one of the largest studies on family-centered care. We found that the preterm babies were discharged home earlier, gained more weight and length, and required fewer hospital visits in the hospitals where the staff had received the intervention. Considering the results of the aforementioned Estonian study, the improved staff–parent collaboration in NICUs may have helped the recovery of the preterm babies,” says Itoshima.
His study comparing discharge practices in Finland and in Japan also suggested that parents’ early preparation for discharge to home is a possible mechanism for the shortened length of hospital stay of preterm babies.
Couplet Care Model promoted parent–baby closeness during the first weeks of life in Finland
Couplet Care Model included the care of a preterm newborn close to the parents from the birth, caring for the mother in the same NICU room with the baby, and providing a bed for two parents in the NICU room. This model was introduced in Turku University Hospital NICU in 2022. The data on over 100 preterm babies showed that the Coulet Care Model promoted parent–baby closeness.
“Parents had the first skin-to-skin contact with their preterm babies most commonly 24 hours after birth before the model, which was reduced to only 2 hours after the model was introduced,” explains Itoshima.
His research also showed that parents’ stay with their baby doubled to an average of 21 hours per day after the introduction of the model.
“This was the first study to examine the effect of couplet care on parent–infant closeness – and the effects were large,” says Itoshima.
Parents’ active role is beneficial for the baby
Ryo Itoshima’s dissertation research showed that the Close Collaboration with Parents and the Couplet Care Model can promote staff–parent collaboration and parent–baby closeness to aid the babies’ recovery. Although the implementation of family-centered care is challenging, staff education on communication can enable the staff to collaborate better with parents, which can ultimately promote babies’ recovery in NICUs. Optimisation of architecture and care system to provide couplet care can promote parent–baby closeness which also benefits the babies. His findings provided evidence on the effectiveness of family-centered care interventions.
“Parents have played and continue to play important roles in neonatal intensive care. Our project presented some specific initiatives to support their roles for the benefit of the babies,” concludes Itoshima.
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MD Ryo Itoshima defends the dissertation in Paediatrics titled “Effectiveness and implementation fidelity of family-centered care interventions: Close Collaboration with Parents and Couplet Care Model” at the University of Turku on 14 February 2025 at 12.00 (University of Turku, Medisiina D, Alhopuro auditorium, Kiinamyllynkatu 10, Turku).
The audience can also participate in the defence remotely.
Opponent: Director Terrie Inder, MD, PhD (Children’s Hospital of Orange County, USA)
Custos: Professor Liisa Lehtonen, MD, PhD (University of Turku)
Contact information: ryitos@utu.fi
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