A Combined Care Model for Preterm Infants with Staged Family Involvement (A Single-Center Comparative Study with 3-Year Follow-Up)

Introduction. Family-centered and family-integrated care are increasingly regarded as important components of modern care for preterm infants. However, in Neonatal Intensive Care Units with traditionally closed policies, immediate implementation of continuous parental presence may be limited by organizational, infection-control, and staffing constraints. Therefore, evaluation of staged family involvement after clinical stabilization is of practical relevance.

Aim: to evaluate the clinical effectiveness of a combined care model including unaccompanied intensive care during the acute phase followed by staged parental participation in preterm infants.

Materials and methods. This single-center comparative study included 120 preterm infants admitted to the neonatal intensive care unit in 2021–2024. The study did not focus on a single nosological entity; rather, it evaluated a clinically heterogeneous cohort of preterm infants requiring treatment and care in the neonatal intensive care setting. The intervention group (n=60) received a combined model of unaccompanied care followed by staged family involvement, whereas the control group (n=60) received conventional unaccompanied care. Study measures included length of hospital stay, weight gain velocity, complications, breastfeeding at discharge, parental competence, parent-infant attachment, and age-appropriate growth/ development at 3 years. Parental competence and parent-infant attachment were assessed using local structured questionnaires with conversion of total scores to a 100-point scale. Mean differences (MD) and relative risks (RR) with 95% confidence intervals (95% CI) were additionally calculated.

Results. The combined model was associated with shorter hospitalization (29.8±5.6 vs 36.5±6.2 days; MD -6.70; 95% CI -8.84 to -4.56; p <0.001), higher weight gain velocity (19.5±3.1 vs 14.2±2.8 g/day; MD 5.30; 95% CI 4.23 to 6.37; p <0.001), lower complication rates (11.7% vs 28.3%; RR 0.41; 95% CI 0.18 to 0.92; p=0.022), and higher breastfeeding rates at discharge (81.7% vs 56.7%; RR 1.44; 95% CI 1.12 to 1.85; p=0.003). Parental competence, attachment, satisfaction, and the proportion of children with age-appropriate growth/development at 3 years were also higher in the intervention group.

Conclusion. A staged model combining controlled intensive care with family-integrated care may improve selected short-term hospital parameters and 3-year follow-up measures in preterm infants and can be considered a pragmatic pathway for Neonatal Intensive Care Units transitioning from closed policies to family-centered care.

1. Ohuma EO, Moller AB, Bradley E, et al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023;402(10409):1261–1271. doi: 10.1016/S0140-6736(23)00878-4 Erratum in: Lancet. 2024;403(10427):618. doi: 10.1016/S0140-6736(24)00267-8

2. Arya S, Naburi H, Kawaza K, et al. Immediate “Kangaroo Mother Care” and survival of infants with low birth weight. N Engl J Med. 2021;384(21):2028–2038. doi: 10.1056/NEJMoa2026486

3. Sivanandan S, Sankar MJ. Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis. BMJ Glob Health. 2023;8(6):e010728. doi: 10.1136/bmjgh-2022-010728

4. Lee J. Neonatal family-centered care: evidence and practice models. Clin Exp Pediatr. 2024;67(4):171–177. doi: 10.3345/cep.2023.00367

5. Waddington C, van Veenendaal NR, O’Brien K, Patel N. Family integrated care: supporting parents as primary caregivers in the neonatal intensive care unit. Pediatr Investig. 2021;5(2):148–154. doi: 10.1002/ped4.12277

6. Van Veenendaal NR, van der Schoor SR, Broekman BF, et al. Association of a family integrated care model with paternal mental health outcomes during neonatal hospitalization. JAMA Netw Open. 2022;5(1):e2144720. doi: 10.1001/jamanetworkopen.2021.44720

7. Hei M, Gao X, Li Y, et al. Family integrated care for preterm infants in China: a cluster randomized controlled trial. J Pediatr. 2021;228:36–43.e2. doi: 10.1016/j.jpeds.2020.09.006

8. Leake N, Edney S, Embleton N, et al. Facilitators and barriers to the practice of neonatal family integrated care from the perspective of healthcare professionals: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2025;110(6):e327770. doi: 10.1136/archdischild-2024-327770

9. Mustafina-Bredikhina DM. Organization of the introduction of family-oriented methods of nursing newborns (including premature) babies in hospitals: the current state of the problem. Neonatology: news, opinions, training. 2024;12(3):78–81. doi: 10.33029/2308-2402-2024-12-3-78-81 EDN: ILMJLT

10. Sukhanova EI. Recommendations for supporting lactation in mothers of neonatal intensive care patients: the view of perinatal psychologist. Neonatology: news, opinions, training. 2024;12(3):82–85. doi: 10.33029/2308-2402-2024-12-3-82-85 EDN: HSTPSS

11. Yakhieva-Onikhimovskaya DA, Kolesnikova SM. Current trends in developmental care for premature infants. Public health of the Far East. 2026;(1):78–86. doi: 10.33454/1728-1261-2026-1-78-86 EDN: IJLMEC

12. Tiryaki Ö, Çınar N, Caner İ. The effect of family integrated care on preparing parents with premature infants hospitalized in the neonatal intensive care unit for discharge. J Perinatol. 2024;44(7):1014–1021. doi: 10.1038/s41372-024-01931-5

13. Hodgson CR, Mehra R, Franck LS. Infant and family outcomes and experiences related to family-centered care interventions in the NICU: a systematic review. Children (Basel). 2025;12(3):290. doi: 10.3390/children12030290

14. Raghupathy MK, Parsekar SS, Nayak SR, et al. Effect of family-centered care interventions on motor and neurobehavior development of very preterm infants: a systematic review and meta-analysis. Phys Occup Ther Pediatr. 2025;45(3):257–286. doi: 10.1080/01942638.2024.2449387

15. Zhang Y, Wang S, He W, et al. Family integrated care to improve evidence-based practices for preterm infants in the neonatal intensive care unit: a meta-analysis and systematic review. BMC Nurs. 2026;25(1):140. doi: 10.1186/s12912-026-04309-4

16. Itoshima R, Helenius K, Ahlqvist-Björkroth S, et al. Close collaboration with parents affects the length of stay and growth in preterm infants: a register-based study in Finland. Neonatology. 2024;121(3):351–358. doi: 10.1159/000535517