From policy to practice: implementing a maternal care program in a resource-limited tertiary NICU in Egypt

Abstract

Reducing parent–infant separation and fostering parental involvement are key elements of modern NICU care. We assessed a structured Maternal Care Program (MCP) based on Family-Integrated Care (FICare) principles in a busy, resource-limited tertiary hospital NICU. To assess the outcome, effectiveness and challenges, with the implementation of a structured maternal care program (MCP). In a prospective single-center study, 380 preterm/late-preterm infants were assigned to MCP (n = 190) or conventional care group (CCG) (n = 190) based on maternal compliance to MCP. Subgroups were neonates ≤ 34 weeks gestation (115 vs. 116 group) and > 34 weeks gestation (75 vs. 74 group). MCP involved maternal education, ≥ 6 hours/day, bedside participation, breastfeeding support, and Kangaroo Mother Care. Outcomes included feeding milestones, respiratory support, infection, complications, weight gain, and length of stay. Number of siblings was significantly higher in CCG, while males were predominating sex in MCP (P = 0.00, P < 0.00; respectively). Across both subgroups, MCP showed significant increased exclusive breastfeeding at discharge (P = 0.00) without difference in discharge weight, improved physiological stability (temperature, heart rate), and shortened hospital stay (17 vs. 27 days; P < 0.001) and (8.75 vs. 15.28 days; P < 0.001) in neonates with gestational age ≤ 34 weeks and > 34 weeks gestation; respectively. Among infants ≤ 34 weeks, the MCP group significantly associated with earlier enteral feed initiation (1.96 vs. 3.98 days P = 0.00), shorter full feeds achievement (7.76 vs. 12.89 days; both P < 0.001), with shorter TPN and NGT duration. Oxygen support (6.73 vs. 10.00 days; P < 0.001), antibiotics exposure (12.82 vs. 22.30 days; P < 0.001) and NEC (10.4% vs. 39.7%; P = 0.00) were significantly lower within MCP. In infants > 34 weeks gestation, MCP neonates had earlier feeding initiation (1.43 vs. 2.34 days; P = 0.00), full feeds achievement (5.16 vs. 9.11 days; P = 0.00). MCP was associated with improved outcome as regards breastfeeding, growth, and reduced length of hospital stay, complications, and readmissions, highlighting the importance of maternal engagement in NICU as a key for faster neonatal recovery.