Hospitalising preterm infants in single family rooms versus open bay units: A systematic review and meta-analysis of impact on parents

EClinicalMedicine. 2020 Jun 6;23:100388. doi: 10.1016/j.eclinm.2020.100388. eCollection 2020 Jun.

Abstract

Background: Many parents develop stress-related symptoms and depression when their preterm infant is hospitalised in the neonatal intensive care unit (NICU) after birth. We reviewed the evidence of parent well-being with preterm infants hospitalised in single family rooms (SFRs) or in open bay neonatal units (OBUs).

Methods: For this systematic review and meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP) databases from inception through 22 November 2019 using controlled terms and text words related to prematurity and NICU-design. We included randomised and non-randomised studies comparing outcomes in parents with preterm infants admitted to SFRs or OBUs. Methodological quality was assessed using Cochrane Collaboration's Risk of Bias Tool for randomised controlled trials and the Risk of Bias Tool for Non-Randomised Studies of Interventions (ROBINS-I). Outcomes included: parental stress, satisfaction, participation (presence/involvement/skin-to-skin care), self-efficacy, parent-infant-bonding, depression, anxiety, post-traumatic stress, empowerment, and degree of family-centred care. Summary estimates were calculated using random effects models with standardised mean differences (SMDs). PROSPERO registration: CRD42016050643.

Findings: We identified 614 unique publications. Eleven study populations (1, 850 preterm infants, 1, 549 mothers and 379 fathers) were included. All but one study were at serious to critical risk of bias. SFRs were associated with higher levels of parental presence, involvement, and skin-to-skin care. Upon discharge, SFRs were associated with lower stress levels (n = 828 parents, SMD-0·30,95%CI -0·50;-0·09, p<0·004, I2=46%), specifically NICU-related stress (n = 573, SMD-0·42,95%CI -0·61;-0·23, p<0·0001, I2=0%). In majority of studies higher levels of empowerment, family-centred care, and satisfaction was present with SFRs. No differences were found for anxiety, parent-infant bonding, or self-efficacy. Depression was high (up to 29%) but not different between settings. No studies described post-traumatic stress.

Interpretation: Single family rooms seem to facilitate parental presence, involvement, skin-to-skin care, and reduce NICU-related parental stress.

Keywords: AA, at admission; BA, before-after study; BDI, Beck Depression Inventory; CI, confidence interval; EPDS, Edinburgh Postnatal Depression Scale; FCC, Family-Centred Care; FCCS, Family-Centred Care Survey; MPAS, Maternal Postnatal Attachment Scale; Mo, months; NA, not applicable; NICU, Neonatal Intensive Care Unit; NR, not reported; NRPI, non-randomised prospective intervention study; NRRI, non-randomised retrospective intervention study; OBU, Open Bay Unit; PES, Parent Expectations Scale; PG, Press Ganey NICU Survey; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analysis; PROSPERO, International Prospective Register of Systematic Reviews; PSI, Parental Stress Index; PSS-NICU, Parental Stressor Scale – NICU; RCT, Randomised Controlled Trial; ROBINS-I, Risk of Bias in Non-randomised Studies of Interventions; RoB, Risk of Bias; SD, standard deviation; SFR, Single Family Room; SMD, standardised mean difference; SPSQ, Swedish Parental Stress Index; STAI, State-Trait Anxiety Inventory; Wks, weeks.