Abstract
Background
During hospital stay after birth, preterm infants are susceptible to late-onset sepsis (LOS).
Objective
To study the effect of family integrated care in single family rooms (SFRs) compared to standard care in open bay units (OBUs) on LOS. Peripheral or central venous catheters (PVCs/CVCs) and parenteral nutrition (PN) were investigated as potential mediators. Secondary outcomes were length of stay, exclusive breastfeeding at discharge, and weight gain during hospital stay.
Methods
Single-center retrospective before-after study with preterm infants admitted ≥3 days.
Results
We studied 1,046 infants (468 in SFRs, 578 in OBUs, median gestational age 35 weeks). SFRs were associated with less LOS (adjusted odds ratio (OR) 0.486, 95% confidence interval (CI): 0.293; 0.807, p = 0.005). PVCs (indirect effect −1.757, 95% CI: −2.738; −1.068), CVCs (indirect effect −1.002, 95% CI: −2.481; 0.092), and PN (indirect effect −1.784, 95% CI: −2.688; −1.114) were possible mediators of the effect. PN was the main mediator of the effect of SFRs on LOS. We found shorter length of stay (median length of stay in SFRs 10 days and in OBUs 12 days, adjusted β −0.088, 95% CI: −0.159; −0.016, p = 0.016), but no differences in weight gain or exclusive breastfeeding at discharge.
Conclusions
SFRs were associated with decreased incidences of LOS and shorter length of hospital stay. The positive effect of SFRs on LOS was mainly mediated through a decreased use of PN in SFRs.
Impact
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Family integrated care (FICare) in single family rooms for preterm infants was associated with less late-onset sepsis events during hospital stay and a shorter length of hospital stay after birth.
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FICare in single family rooms was associated with less use of peripheral or central venous catheters and parenteral nutrition.
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Mediation analysis provided insights into the mechanisms underlying the effect of FICare in single family rooms on late-onset sepsis and helped explain the differences observed in late-onset sepsis between FICare in single family rooms and open bay units.
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The reduction in late-onset sepsis in FICare in single family rooms was mediated by a reduced use of intravenous catheters and parenteral nutrition.
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Acknowledgements
N.R.v.V. is supported by an unrestricted research grant, provided by Nutricia, the Netherlands, during the conduct of the study. A.A.M.W.v.K. and S.R.D.v.d.S. are supported by research grants, provided by Nutricia, the Netherlands, outside the submitted work.
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N.R.v.V., S.R.D.v.d.S., A.A.M.W.v.K., and J.B.v.G. developed the design and database of this study. N.R.v.V. performed acquisition of the data. N.R.v.V. performed the data analysis. J.J.M.R. provided insights into the use of mediation models, M.W.H. provided insights into the multiple imputation model. M.W.H. provided the script for the bootstrapping of indirect effects in the imputed database. A.A.M.W.v.K. reviewed infants with sepsis events. J.W.R.T. and W.H.H. provided insight into the use of regression models and conduct of the study and data analysis. N.R.v.V. drafted the first version of the manuscript. N.R.v.V., S.R.D.v.d.S., W.H.H., J.J.M.R., M.W.H., J.W.R.T., J.B.v.G., and A.A.M.W.v.K. all contributed to revising the manuscript critically for important intellectual content and approving this paper to be published. N.R.v.V., S.R.D.v.d.S., and A.A.M.W.v.K. are the guarantors of this study; they accept full responsibility for the work and the conduct of the study, had full access to the data, and controlled the decision to publish. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
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This study was reviewed and approved by the Institutional Review Board of OLVG Hospital, Amsterdam, the Netherlands. For this retrospective chart study, no informed consent was required.
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van Veenendaal, N.R., van der Schoor, S.R.D., Heideman, W.H. et al. Family integrated care in single family rooms for preterm infants and late-onset sepsis: a retrospective study and mediation analysis. Pediatr Res 88, 593–600 (2020). https://doi.org/10.1038/s41390-020-0875-9
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DOI: https://doi.org/10.1038/s41390-020-0875-9
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