Family Integrated Care in Single Family Rooms and Neonatal Outcomes in Preterm Infants: A Multicenter Cohort Study

Abstract – Introduction: We aimed to evaluate the effect of Family Integrated Care (FICare) in single family rooms (SFR) on infant outcomes, compared with standard neonatal care (SNC) in open bay units (OBU). Methods: A prospective cohort study was conducted in three Dutch level II neonatal units. Preterm infants hospitalized ≥7 days were included between 2017 and 2020. The intervention site provided FICare in SFR; control sites provided SNC in OBU. Predefined secondary outcomes included length of stay (LOS), breastfeeding, growth, late-onset sepsis, days with tube feeding (TF), respiratory support and intravenous access, discharge with TF, and readmissions. Linear mixed models accounting for multiple births, and exploratory mediation analyses, were used. Results: A total of 358 infants were included (169 FICare; 189 SNC; median gestational age 33⁺³ weeks [interquartile range 30⁺⁵–35⁺⁰]). FICare was associated with a 9% reduction in LOS (adjusted mean ratio [aMR] 0.91 ≈ 2 days, 95% CI 0.84–0.99). Infants in the FICare group were more likely to be discharged with TF (adjusted odds ratio 5.77, 95% CI 2.25–14.79) and had fewer days with TF in hospital (aMR 0.79, 95% CI 0.66–0.94) and intravenous access (adjusted incidence rate ratio 0.55, 95% CI 0.39–0.76), while maintaining similar growth and readmission rates. Days with TF and intravenous access fully mediated the effect on LOS (adjusted total indirect effect 0.91, 95% CI 0.85–0.97). Other outcomes did not differ. Conclusions: FICare in SFR was associated with decreased LOS, mediated by acquiring feeding skills. Further research should include robust study designs, including diverse parental populations.