The important role of parents in the NICU

As part of the UNICEF Baby Friendly Initiative’s guidance to neonatal units, managing parents’ experience of care is cited as a key foundation in ensuring the optimal care and recovery of NICU patients².

By enabling parents of preterm babies in the NICU to participate in the care of their child, they will know how to care for the infant following discharge from the hospital³, with the added important benefit of strengthening their emotional bond with the infant^4,5. Touch is a critical component of strengthening this bond³ and there are multiple ways parents can be more involved in the day-to-day care of their newborn in the NICU.

According to leading neonatal charities throughout the world dedicated to the care of critically ill and premature babies, parents can be involved in the daily care of their premature infants with the support of nurses, particularly when it comes to⁶:

• Bathing

• Changing nappies

• Kangaroo mother care

• Holding and comforting baby

• Providing breastmilk

Bathing

Parents of premature babies can be tentative about handling their newborn. Nurses play a vital role in educating parents about the delicate nature of a premature infant’s skin to empower them to be involved in their baby’s daily care. Sponge bathing is usually deemed the safest and most beneficial form of cleaning a premature infant⁷.

Fast facts for parents about premature babies’ skin

• Premature infants are skinnier and have less body fat⁸

• The skin of a premature baby can be extremely red but is actually translucent as it is not yet fully developed⁹

• A premature baby’s skin is very thin, sensitive and prone to irritation, especially nappy rash^6,7,8

Changing nappies

Cleaning the nappy area is important in order to protect a premature baby’s delicate skin. Whilst hospitals will usually have their own preferred methods, parents often seek guidance for a commercial wipe following hospital discharge. A review published in Paediatric Dermatology⁶found that wipes containing ingredients such as glycerin and citric acid can be harmful to the pH of a premature infant’s skin compared to cloth and water. A wipe with minimal ingredients, such as WaterWipes which contains 99.9% purified water and a drop of fruit extract, helps maintain the important skin barrier function of the stratum corneum. WaterWipes are the preferred wipe for many NICUs throughout Australia and New Zealand and around the world.

Kangaroo mother care

Kangaroo care, often used interchangeably with skin-to-skin contact (SSC), is a long-established practice in hospitals and NICU worldwide. Provided SSC is safely administered¹⁰, it has been associated with improving newborn physiologic stability, promoting breastfeeding and healthy growth and development.^11,12,13,14

Benefits to Baby

• Maintain baby’s body temperature

• Regulates baby’s heart and breathing rates

• Encourages baby to spend more time in a deep sleep

• Increases baby’s weight gain

• Improved oxygen saturation levels

• Can improve breast milk production and increases the chances of successful breastfeeding

• Longer periods of alertness

• Helps promote frequent breastfeeding

Benefits to parents

• Building parental confidence

• Increasing their bond with baby and can ease feelings of separation, positively impacting the mental wellbeing of the parents

• Improving breast milk production and increasing the chances of successful breastfeeding

Fathers and skin-to-skin contact

Fathers can also benefit from SCC¹⁵ with reduced spousal relationship problems¹⁶; strengthening of their paternal role¹⁶, and helping them transition into a more equal parenthood.²⁰

The power of SSC

To demonstrate the true power of SSC between parents and newborns, WaterWipes teamed up with one of the world’s leading experts on kangaroo care, Dr. Susan Ludington to track the impact of SSC on three newborns. Check out the powerful videos to see how SSC regulated their baby’s breathing, heart rate, oxygen levels and temperature within five minutes of being held in this position.

Holding and comforting baby

SSC may not be appropriate for certain premature infants, but parents should not be discouraged as their touch can be just as powerful. Parents may not realise but a simple touch can¹⁷:

• Calm baby during uncomfortable or painful procedures

• Soothe a restless baby

• Encourage baby to be quietly awake and responsive

This can take many forms, such as simply holding baby for shorter periods of time, swaddling, encouraging suckling, massage or simply lying close to the baby’s incubator^21,18,19,20.Encourage parents to explore ways they can physically engage with their babies in the NICU as every baby is unique and will respond differently.

Did you know?

The skin is the largest sense organ, and the first to develop, even within the womb, so all newborns are wired to respond to touch.²⁴ A newborn continuously receives stimulation through being breastfed and cuddled, which is vital for both growth and development.^24,21

Did you know?

Parents of premature babies are 2.5 times more likely to suffer postnatal depression. and one in five parents who have had an extremely preterm birth (before 30 weeks) still show symptoms of depression and anxiety six months postpartum.

It isn’t just mothers that are affected, fathers to very premature babies are also at increased risk with one third experiencing high rates of depression and half suffering elevated anxiety levels..^27,28,29

Maternal skin-to-skin contact in the NICU can have a positive impact on the mother too, including improved mood, a decrease in stress and postpartum depression, in addition to stimulating a care-giving environment.^22,23,24

Summary

Enabling parents to take an active role in their baby’s care significantly improves their experience in the NICU.

It is important to remember, parents know their baby better than anyone. Advocating the important role of parents in the NICU is crucial not only for the baby’s development but to empower parents as the baby’s primary caregivers. This is especially important as baby transitions toward home. Parents who are actively involved in the care of their baby in the NICU will see a positive impact on their baby and also their own mental health and parent-child bonding.

Lucille Bradfield, Clinical Nurse Manager Neonatal

WaterWipes is proud to support NICUs and premature baby organisations around the world including Miracle Babies Foundation (Australia).

Accessing support for families

Miracle Babies NurtureLine: 1300 MBABIES or 1300 622 243

In Australia, families to a premature or sick newborn can access emotional support through organisations such as Miracle Babies Foundation. The Miracle Babies 24 Hour Family Support Line (NurtureLine) provides access to a trained support team and can assist parents and extended family members in coping with the experience of having a baby remain under the care of the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN), and beyond after discharge.

Face-to Face Support in hospital

Whilst babies remain in hospital, face-to-face support services also run in many NICUs and Special Care Nurseries nationally (NurtureTime). During these services, Miracle Babies Foundation Support Teams visit the units to provide much needed support to these families. Families can check www.miraclebabies.org.au to see whether this service is available at their hospital.

Miracle Babies Foundation also provides tools, resources and information to families. Distributed to them via the hospital (participating hospitals).

Useful resources

In addition to the leaflets for parents your hospital may already provide, below are some useful resources for you to help educate and empower parents in their care of their premature baby:

Unicef: You and your baby: Supporting love and nurture on the neonatal unit

Bliss: Resources for parents

Tommys: Your premature baby's time in hospital