Effect of family integrated care on stress in mothers of preterm infants: A multicenter cluster randomized controlled trial

Background: Reducing mother-infant separation in early life is a key breakthrough in the care improvement model in the neonatal intensive care unit (NICU). Previously, we reported effect of family integrated care (FICare) on clinical outcomes of preterm infants. We further clarify effect of FICare on maternal stress. Methods: Mothers of preterm infants at eleven NICUs were randomized to the FICare group and the control group. The primary outcome was the reduction in Parental Stress Scale: NICU (PSS:NICU) score from enrollment to discharge. Results: Total of 601 mothers (298 in FICare and 303 in control groups) enrolled. There was no significant difference in PSS:NICU score between the 2 groups at enrollment (P = 0.824), and the FICare group had lower scores at discharge (P < 0.001). PSS:NICU scores of both groups were significantly decreased at discharge compared to at enrollment (P < 0.001), and the reduction was greater in the FICare group (P < 0.001). After applying linear regressions to adjust for potential confounders, results remained unchanged (adjusted P < 0.001). PSS:NICU score reductions from enrollment to discharge were positively correlated with maternal age in the control group (rho = 0.147, P = 0.011). Limitations: This study was limited to post-hoc analyses and did not include follow-up to evaluate long-term effects. Conclusions: FICare is helpful for reducing maternal stress in preterm infants in the NICU. Older mothers tend to have limited improvements in stress after traditional nonparent care, which suggests that they may benefit more from the FICare model.