# An investigation into the impact of family integrated care on extrauterine growth restriction at discharge in very low birth weight infants: a multi-centre study

## TL;DR

This study found that family integrated care helps reduce growth issues in very low birth weight infants at hospital discharge.

## Contribution

The study provides new evidence on how parental involvement in NICUs affects growth outcomes in preterm infants.

## Key findings

- Higher birth weight and family integrated care were protective against growth restriction at discharge.
- Infants born before 28 weeks and those with low Apgar scores were at higher risk for growth issues.
- More than 18 hours of family integrated care was most effective in reducing growth restriction risk.

## Abstract

Family integrated care (FIC) encourages parental involvement in neonatal intensive care units (NICU) and has been found to promote weight gain in preterm infants. Extrauterine growth restriction (EUGR) results from inadequate growth among very low birth weight infants (VLBWI), which has been found to contribute to parental anxiety. To address an existing gap in research, we aimed to examine the impact of parental involvement on EUGR at discharge in VLBWI.

We conducted a retrospective, multi-centre case-control study involving VLBWIs admitted to 17 NICUs across eight southeastern Chinese provinces and cities from February 2021 to November 2023. We categorised cases and control groups based on the presence of EUGR at discharge and compared their perinatal and hospitalisation characteristics, as well as FIC duration, using a generalised linear mixed model.

EUGR in VLBWI at discharge was associated with birth weight (odds ratio (OR) = 0.547; 95% confidence interval (CI) = 0.490, 0.610), gestational week (<28 weeks) (OR = 3.101; 95% CI = 1.909, 5.038), Apgar score at 1 minute ≤7 (OR = 1.525; 95% CI = 1.119, 2.079), being small for gestational age (OR = 3.269; 95% CI = 1.547, 6.908), maternal gestational hypertension (OR = 1.868; 95% CI = 1.270, 2.748), necrotising enterocolitis (OR = 2.254; 95% CI = 1.386, 3.667), and total FIC duration. Based on literature and clinical practice, we divided the total FIC duration into three groups. We found that the lowest OR was associated with >18 hours of care, followed by ≤18 hours, while the highest was associated with 0 hours of care.

We identified higher birth weight and FIC as protective factors against EUGR at discharge in VLBWI. In contrast, we recognised gestational age <28 weeks, an Apgar score ≤7 at 1 minute, small for gestational age, maternal gestational hypertension, and necrotising enterocolitis as risk factors. Nevertheless, further research is required to analyse the relationship between FIC and EUGR at discharge.

ClinicalTrials.gov (NCT06550440).