The global scope and components of family-centred care for preterm infants: An umbrella review.

Abstract

Preterm birth is the leading cause of under-five mortality. Family-centred care (FCC) interventions may improve outcomes related to prematurity and may be used to address this issue to achieve the Sustainable Development Goals. We aimed to consolidate the scope of evidence and components of FCC interventions for preterm infants globally and see its relevance for low-resource settings. We conducted an umbrella review informed by the Joanna Briggs Institute (JBI) guidelines. Systematic literature reviews evaluating FCC in the preterm or high-risk infant population and their families were identified from six databases. Keywords included "family-centred care", "premature infants", "neonatal intensive care unit", and their relevant synonyms. Quality appraisal was conducted using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and data extraction performed to an agreed table. Thematic analysis was carried out to categorise the components of FCC interventions. Forty-four reviews were included in the umbrella review. Outcomes were observed on the parents in 40 studies, the infant in 19, the health care provider in 13, and the health system in 7. Most studies focused on inpatient settings (79.6%) and were conducted primarily in high-income countries (92.3%). The components identified were general FCC, health system design, parent support, partnership in care, and information and communication. Overall, FCC interventions have a positive impact on parental, infant, and health system outcomes, with consistent reporting of FCC impact on parental well-being and satisfaction, infant length of stay, feeding and growth, and hospital readmission rates. FCC interventions have the potential to improve preterm infant health system outcomes. To maximise impact, FCC interventions need to be further explored in low-resource and post-discharge settings, where the burden of premature infant morbidity and mortality is highest. Evidence in both these settings is scarce. Future research efforts should aim to close these evidence gaps.