Heather H. Burris MD, MPH , Niesha Darden , Maggie Power BSN,CNM , Laura Walker BA , Rachel Ledyard MPH , Joseph Reiter MS , Jennifer Lewey MD, MPH , Kimberly K. Trout PhD, RN, CNM , Marie Tan BA , Emily F. Gregory MD, MPH , Sara B. DeMauro MD, MSCE , Scott A. Lorch MD, MSCE , Lori Christ MD , Sara C. Handley MD, MSCE , Diana Montoya-Williams MD, MSHP , Celeste Durnwald MD
{"title":"Postpartum care in the neonatal intensive care unit, PeliCaN: a randomized controlled trial","authors":"Heather H. Burris MD, MPH , Niesha Darden , Maggie Power BSN,CNM , Laura Walker BA , Rachel Ledyard MPH , Joseph Reiter MS , Jennifer Lewey MD, MPH , Kimberly K. Trout PhD, RN, CNM , Marie Tan BA , Emily F. Gregory MD, MPH , Sara B. DeMauro MD, MSCE , Scott A. Lorch MD, MSCE , Lori Christ MD , Sara C. Handley MD, MSCE , Diana Montoya-Williams MD, MSHP , Celeste Durnwald MD","doi":"10.1016/j.ajogmf.2025.101689","DOIUrl":null,"url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Postpartum parents of hospitalized infants in neonatal intensive care units have higher rates of chronic disease and pregnancy complications than parents of well newborns. Neonatal intensive care unit parents may prioritize remaining at their infants’ bedsides over their healthcare.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to determine whether embedding doulas and certified nurse midwives for postpartum care in the neonatal intensive care unit (PeliCaN) would reduce the time to receive postpartum healthcare, with the hypothesis that the intervention would shorten the time and improve the comprehensiveness of postpartum care.</div></div><div><h3>STUDY DESIGN</h3><div>This was a parallel randomized controlled trial from November 29, 2022, to November 7, 2023, in a single-center, level 3 neonatal intensive care unit in a tertiary hospital in Philadelphia, Pennsylvania, with approximately 4200 births annually. Postpartum parents of infants who were born at <34 weeks of gestation, <2 weeks old, and anticipated to remain in the neonatal intensive care unit ≥1 week, were eligible. Of the 135 potentially eligible parents, the staff screened 78 for eligibility (constrained by access to just 4 hours per week of midwifery care), contacted 52 of 71 eligible parents, and enrolled 37 by 2 weeks after delivery. There were 20 parents randomized to the intervention group and 17 parents randomized to the control group via block randomization stratified by gestational age (<29 and ≥29 weeks) and insurance (public and private). The intervention consisted of postpartum doula support and midwifery clinical care in the neonatal intensive care unit for the duration of the infant’s hospitalization. Participants in the control group received usual care. The outcomes were measured at 12 weeks after delivery. All participants had complete follow-up data. The primary outcome was days to receive any postpartum care and to completion of 3 care components: blood pressure measurement and treatment if needed; depression screening and referral and treatment if indicated; and contraception counseling (if no sterilization procedure had been performed) and provision if patients desired. Planned secondary analyses included stratification by gestational age and insurance as well as assessing the rates of any postpartum care receipt.</div></div><div><h3>RESULTS</h3><div>Six participants (30.0%) in the intervention group and 6 participants (35.0%) in the control group were parents of infants born at <29 weeks of gestation, and 16 participants (80.0%) in the intervention group and 15 participants (88.2%) in the control group were publicly insured. The median times to the first postpartum visit were 11 days (interquartile range, 10–12) in the intervention group and 31 days (interquartile range, 26–37) in the control group (<em>P</em><.001). In addition, 1 participant (5%) in the intervention group and 6 participants (35%) in the control group missed at least 1 of 3 care components, most commonly blood pressure measurements. Of note, 4 participants (23%) in the control group did not have a blood pressure measurement, one of whom had preeclampsia. There were no differences in outcomes by infant gestational age or insurance.</div></div><div><h3>CONCLUSION</h3><div>In this single-center randomized controlled trial, the postpartum care in the neonatal intensive care unit model of on-site doula and midwifery care, PeliCaN, expedited and enhanced postpartum care. Multicenter trials and implementation science work are urgently needed to establish broader utility and feasibility.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 7","pages":"Article 101689"},"PeriodicalIF":3.8000,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Obstetrics & Gynecology Mfm","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589933325000898","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
BACKGROUND
Postpartum parents of hospitalized infants in neonatal intensive care units have higher rates of chronic disease and pregnancy complications than parents of well newborns. Neonatal intensive care unit parents may prioritize remaining at their infants’ bedsides over their healthcare.
OBJECTIVE
This study aimed to determine whether embedding doulas and certified nurse midwives for postpartum care in the neonatal intensive care unit (PeliCaN) would reduce the time to receive postpartum healthcare, with the hypothesis that the intervention would shorten the time and improve the comprehensiveness of postpartum care.
STUDY DESIGN
This was a parallel randomized controlled trial from November 29, 2022, to November 7, 2023, in a single-center, level 3 neonatal intensive care unit in a tertiary hospital in Philadelphia, Pennsylvania, with approximately 4200 births annually. Postpartum parents of infants who were born at <34 weeks of gestation, <2 weeks old, and anticipated to remain in the neonatal intensive care unit ≥1 week, were eligible. Of the 135 potentially eligible parents, the staff screened 78 for eligibility (constrained by access to just 4 hours per week of midwifery care), contacted 52 of 71 eligible parents, and enrolled 37 by 2 weeks after delivery. There were 20 parents randomized to the intervention group and 17 parents randomized to the control group via block randomization stratified by gestational age (<29 and ≥29 weeks) and insurance (public and private). The intervention consisted of postpartum doula support and midwifery clinical care in the neonatal intensive care unit for the duration of the infant’s hospitalization. Participants in the control group received usual care. The outcomes were measured at 12 weeks after delivery. All participants had complete follow-up data. The primary outcome was days to receive any postpartum care and to completion of 3 care components: blood pressure measurement and treatment if needed; depression screening and referral and treatment if indicated; and contraception counseling (if no sterilization procedure had been performed) and provision if patients desired. Planned secondary analyses included stratification by gestational age and insurance as well as assessing the rates of any postpartum care receipt.
RESULTS
Six participants (30.0%) in the intervention group and 6 participants (35.0%) in the control group were parents of infants born at <29 weeks of gestation, and 16 participants (80.0%) in the intervention group and 15 participants (88.2%) in the control group were publicly insured. The median times to the first postpartum visit were 11 days (interquartile range, 10–12) in the intervention group and 31 days (interquartile range, 26–37) in the control group (P<.001). In addition, 1 participant (5%) in the intervention group and 6 participants (35%) in the control group missed at least 1 of 3 care components, most commonly blood pressure measurements. Of note, 4 participants (23%) in the control group did not have a blood pressure measurement, one of whom had preeclampsia. There were no differences in outcomes by infant gestational age or insurance.
CONCLUSION
In this single-center randomized controlled trial, the postpartum care in the neonatal intensive care unit model of on-site doula and midwifery care, PeliCaN, expedited and enhanced postpartum care. Multicenter trials and implementation science work are urgently needed to establish broader utility and feasibility.
期刊介绍:
The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including:
Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women.
Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health.
Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child.
Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby.
Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.