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Indian Pediatr 2019;56:336-337

Mother-Neonatal Intensive Care Unit – A New Model of Family Participatory Care?

Harish Kumar1 and Lily Kak2

From 1Vridhi Project, New Delhi; and 2Newborn Health, US Agency for International Development, Washington DC.
Email: harishalwadhi@hotmail.com


We read with great interest the article on Mother-Neonatal Intensive Care Unit (M-NICU) published in a recent article in Indian Pediatris [1]. This model of care seeks to operationalize two key concepts that are widely accepted as part of optimal care for newborns–integration of maternal and newborn care, and family engagement.

The Ministry of Health and Family Welfare (MOHFW), Government of India, through its National Health Mission (NHM), has demonstrated exemplary leadership in responding and adapting to the evolving needs of India’s program for small and sick newborns. Recent inclusion of Family Participatory Care (FPC) as a national health program innovation in newborn care and launch of a Training Guide and FPC Operational Guidelines [2] are steps in this direction.

Chellani, et al. [1] have introduced M-NICU as a novel model that tests the feasibility of zero-separation of the mother and newborn, thus taking the FPC model a step further in increasing family engagement. M-NICU is a collaborative effort between the neonatology and obstetrics departments. It positions the mother’s bed in the NICU, providing an opportunity for the mother and her newborn to be together continuously throughout the hospital stay. While this model is a laudable effort in increasing family engagement in the care of small and sick newborns, it raises many questions regarding implementation.

Evidence from India and other countries [3,4] indicate that the family-centred care model does not increase nosocomial infection; does this hold true in the M-NICU model of family-centred care? How is hygiene maintained in a model that widens the circle of family members and health providers who come in contact with the newborn? Are the health staff of the Obstetrics and Neonatology departments trained together in infection prevention and developmentally supportive care? What are the cost implications of a model that requires enhanced infrastructure support and additional space requirements?

The development of a structured, implementable framework for family-centred care in the Indian setting has provided an opportunity for iterative learning for 12 years. From these lessons, we anticipate two major challenges: the attitude of the health care provider (rather than that of the family) and the structural modification that will be required in the NICU space.

Feasibility and acceptability of the family-centred model as a winning strategy for increasing rates of Kangaroo Mother Care and for facilitating developmentally supportive care, has been documented in the Indian setting. Data from 38 District Special Newborn Care Units (SNCUs) have demonstrated that family-centred care is a feasible model within the Indian public sector health system. A qualitative study has shown not only a high degree of acceptability among both parents and service providers but also that essential newborn care skills acquired by parents during hospital stay with their sick neonate continues when they return home. The study also documented an improved patient-staff relations, a highly needed area in the India health care system.

While family-centred, developmentally supportive care is the standard model in many high-income countries, India has blazed the trail [5] as the first among low- and middle-income countries to have introduced a national policy to integrate family-centred care in all sick newborn care units. We anticipate many challenges that will need to be overcome in the national rollout of the FPC model, and in the adaptation and integration of the M-NICU model to further deepen FPC in SNCUs at scale.


1. Mother-Neonatal Intensive Care Unit (M-NICU): A novel concept in newborn care. Indian Pediatr. 2018;12:1035-6.

2. Operational Guidelines on Family Participatory Care, July 2017 MOHFW, GOI publication. Available from: http://nhm.gov.in/images/pdf/programmes/child-health/guidelines /Family_Participatory_Care_for_Improving_ Newborn_Health-Operational_ guideline.pdf. Accessed January 04, 2019.

3. 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.

4. Ortenstrand A, Westrup B, Broström EB, Sarman I, Åkerström S, Brune T, et al. The Stockholm Neonatal Family Centered Care Study: Effects on length of stay and infant morbidity. Pediatrics. 2010;125:278-85.

5. India Case Study on Family Participatory care: A Gateway to Nurturing Care for Small and Sick Newborn Included for Launch of Nurturing Care framework Launch for Early Childhood Development at 71st World Health Assembly May 2018 at Geneva. Available from: http://nurturing-care.org/wp-content/uploads/2018/05/nurturing-care-case-study-india.pdf. Accessed January 04, 2019.


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