We thank the authors for reading our pilot work on
family-centered care (FCC) [1].
Elaborate discrete description of principles of FCC
has existed in medical literature for over two decades [2]. However,
there is hardly any literature about as to what constitutes translating
and adapting principles of FCC into operational models of FCC into day
to day practice. We translated and adapted principles of FCC to an
operational model to empower and build competencies of parent attendants
for essential caregiving skills to their sick neonates. Comprehensive
audio-visual training modules were developed to achieve this in a
standardized manner.
The present study that was conducted in 2010-12, was
designed as an efficacy trial to test the intervention of FCC for impact
on pertinent outcomes such as nosocomial infection rates (primary) and
hospitalization duration, exclusive breastfeeding rates at discharge,
and mortality (secondary outcomes) between the two groups. However after
this preliminary trial, we have been working iteratively to develop a
more pragmatic model of implementation that has been tested and found
feasible across all stakeholders (nurses, doctors and
parent-attendants). Presently FCC has become a standard of care practice
in our NICU and allows flexibility with regard to either wilfulness or
extent of participation by the parent attendants. Our model recommends a
checklist required for implementation of FCC including the need of
mother- friendly facilities to enable her to rest and recoup besides
being engaged in processes of care for her sick baby.
1. Being a preliminary pilot intervention study,
we were conservative in our inclusion criteria. Thus we excluded
hemodynamically unstable and critically sick babies as well as the
multiple gestations, who were all predominantly preterms. This may
be the reason of mean gestation in our study to be advanced. As such
the proportion of preterms in our study was 28.8%.
2. The mean time spent bedside was shared between
two to three attendants who took turns in a day per baby to spend
this time with their babies. We do agree that spending this time
with their respective baby could lead to fatigue. One may consider
assessment of the same by incorporating fatigue scores in future
studies as suggested by the authors.
3. We agree that noting actual time spent by the
attendants prospectively in parent sheet would have reduced the
recall bias. However, actual time spent by the attendants was not a
primary/secondary objective, and hence was recorded in a feasible
manner in this study.
4. Inclusion criteria in our study required
presence of at least two accompanying attendants per baby. It would
not be feasible to have four or six attendants available (as would
accordingly be required for twins or triplets respectively) to
participate in caregiving from a family, and hence we excluded
multiple births from the study.
Sure enough, we agree with the authors that FCC seems
to be the beginning of a new era in India. Follow-up studies of the FCC
cohorts will be important to document impact of this promising social
collaborative partnership on neonatal outcomes. Evaluation of the method
at scale is an implementation science question of some importance, in
order to show that successful pilot studies in tertiary centers are not
attenuated when scaled up through district facilities [3].
1. Verma A, Maria A, Pandey RM, Hans C, Verma A,
Sherwani F. Family-centered care to complement care of sick newborns: A
randomized controlled trial. Indian Pediatr. 2017;54:455-9.
2. Eichner JM, Johnson BH. Family-centered care and
the pediatrician’s role policy statement. Pediatrics. 2003;112:691-6.
3. Costello A. Quality, equity and dignity for preterm infants
through family-centered care. Indian Pediatr. 2017;54: 451-2.
