NICU fosters first-hold bonding between parents and critically ill infants

Mothers are able to hold their babies sooner in the Neonatal Intensive Care Unit (NICU), thanks to research based at Christiana Care. The change is welcome to the care team and many parents who previously would have had to wait a median six days before they could hold their critically ill newborn.

Research suggests early skin-to-skin contact between a parent and infant provides multiple benefits, including reduced infant mortality, improved cardiorespiratory stability and temperature regulation, decreased length of hospital stay, increased breast milk production in the mother and higher rates of breastfeeding, and increased parental  satisfaction and confidence in caring for their baby.

Kaitlin Kenaley, M.D.
Kaitlin Kenaley, M.D.

“We had a very positive response in the NICU, with everyone recognizing the importance of overcoming obstacles so parents can hold their newborns for the betterment of their health,” said Neonatology Fellow Kaitlin M. Kenaley, M.D. She presented the findings in a paper and poster discussion in September at the Vermont Oxford Network’s Annual Quality Congress and NICQ & iNICQ Symposium in Chicago.

She explained how Christiana Care collaborated to decrease time-to-first-hold from a median of six days to a median of one day. The achievement surpassed the goal for babies requiring mechanical ventilation. Christiana Care’s NICU team is working toward a long-term goal of 75 percent of newborns who require mechanical ventilation being held within 24 hours.

“Families are often anxious when they see their baby in the NICU for the first time connected to catheters, tubes and wires,” said neonatologist Julia D. Ryan, M.D. “Our goal is to help families feel empowered to hold their newborns soon after delivery to improve early parental bonding and to make this experience a little less stressful.”

A key to success was a team approach that included neonatal attending physicians, a fellow, nurse practitioners, nurses, respiratory therapists, and physical and occupational therapists. Along with Dr. Kenaley, co-leaders of the Lean Six Sigma project were Dr. Ryan, John L. Stefano, M.D., director, Department of Neonatology, and Annette L. Rickolt, MSN, APN, RNC, clinical nurse specialist.

“I feel great because the changes we’ve implemented are so beneficial to the health of our newborns, and these are changes our nurses, who provide so much of our care, have really taken to,” Dr. Stefano said.

Discussions with staff on sustainability of important aspects of the project have led to changes that include:

  • Encouraging parental holding during a mother’s prenatal consults.
  • Reaching consensus on NICU guidelines on medical stability among the staff so everyone is aware of a unified policy.
  • Improving education of staff and families.
  • Ensuring proper staffing is in place to support early holding.
  • Altering the physical layout in NICU rooms so intubation and monitoring are not obstacles.
  • Creating a nursing checklist to support the first parental hold.

“We have worked on communication and broken down a lot of the barriers to make sure that our staff can feel comfortable with our changes,” Dr. Ryan said.