Family-centred care: a strategy for the optimal development of premature infants


"Fear and confusion. I think those were the strongest feelings". Lautaro was born at 32 weeks and this is how Sofia, his mother, remembers the first days of the experience. 

"I remember that I lived all that as a state of unreality. Nothing was as we had imagined... Lauti was born in February of this year and I still find it hard to put my thoughts in order about everything we experienced at that moment". 

Premature birth is an unexpected event that places people born prematurely and their families in a situation of great vulnerability. It is a very sensitive period in the life course, in which, among many other aspects, the bond of attachment, so important for the healthy growth, development and future life of the newborn, is established.  

Sofia is 36 years old, from Uruguay, and Lautaro is her first child. 

"I remember with great anguish the moment I was discharged from the hospital. What did that mean? Did I have to leave my baby there and go home? It was terrible. People were telling me to try to rest, that my baby needed me strong, and I couldn't believe they were asking me to leave him".  

Every November 17, Prematurity Day is celebrated in order to give visibility to this problem and raise awareness about the needs and rights of premature babies and their families.

This year's Prematurity Day focuses on the need for unrestricted admission of families into Neonatal Intensive, Intermediate or Low Complexity Care Units.  "This is essential to achieve optimal skin-to-skin contact, to achieve breastfeeding and to engage and encourage mothers and fathers to care for their children," said the regional advisor on Perinatal Health of the Pan American Health Organization (PAHO/WHO), Pablo Durán. 

The advisor referred, in particular, to the kangaroo mother method: "It is an intervention that allows the mother to assume a central role in the care of her baby". According to data from the World Health Organisation (WHO), the kangaroo method reduces the risk of neonatal mortality by 32%. "Babies should stay with their mothers as long as possible and practice skin-to-skin contact so that breastfeeding can begin as soon as possible. Breastfeeding and early attachment have positive impacts on babies, particularly premature babies, and have lifelong benefits".

In the Americas region, nearly 1 in 10 babies is born prematurely. This represents more than one million newborns each year. 

Premature babies require specialised attention and specific care to enable them to survive, grow and develop healthily. Complications of prematurity are the leading cause of death in the neonatal period. In addition, survivors of preterm birth may suffer lifelong health consequences, with an increased likelihood of disability and developmental delays. 

In this context, family-centred care is a right that must be ensured and promoted by health teams.  

Newborn health has been defined as part of the "unfinished agenda" of the Millennium Development Goals for women's and children's health.  

Sustainable Development Goal 3.2 establishes an end to preventable deaths of newborns and children under 5 years of age, with the goal of reducing neonatal mortality to at least 12 per 1,000 live births and mortality of children under 5 years of age to, at least 25 per 1,000 live births in all countries by 2030.

Quality, family-centred care can reduce mortality and provide better chances for development.  

For Durán, the involvement of families is fundamental and is a perspective that all health centres caring for newborns should incorporate. "Families are a crucial part of care. They must be accompanied, informed and, above all, their needs must be heard in order to make real progress in quality care that puts the newborn, his or her family and community at the centre".

On her experience with health teams, Sofia says "Support is very important. Not all people have the same empathy. I particularly remember a nurse who helped us a lot. She talked to me with a lot of patience, she calmed me down, she tried to explain to me everything that was happening with my baby. It was reassuring for me every time she was there. Afterwards, I began to form a bond with everyone who was there, but there are people who are more sensitive to accompany these processes" ... "With time, everything became clearer. Fortunately Lauti evolved very well and now we are enjoying it without so much fear".  

The director of the Latin American Centre for Perinatology - Women and Reproductive Health (CLP/WR) said that the centre has been promoting family-centred care for some time. "It is something we will continue to insist on because the evidence shows that it is the right path to quality care. The pandemic has set us back in some aspects, but it is a question of human rights, the focus must always be on the person, in this case, on the babies and their families".  

Serruya said that CLP/WR has developed several tools that integrate this approach. Among them, she highlighted the eCBB application, which provides information on baby care to families and health teams and can be downloaded for free on Google Play and Apple Store. She also referred to the work the centre carries out with a network of organisations of families of premature babies, which currently has 21 groups in 15 countries in the region.