Family integrated care to improve evidence-based practices for preterm infants in the neonatal intensive care unit: a meta-analysis and systematic review

BACKGROUND: Family integrated care (FICare) has been reported as an improved care model with possible clinical benefits for preterm infants in the neonatal intensive care unit (NICU). However, several key questions remain regarding its efficacy and safety. This study was conducted to compare FICare with standard care to improve evidence-based practices for neonatal health. METHODS: Independent researchers searched the Cochrane Library, EMBASE, and Medline databases to identify randomized control trials (RCTs) and cohort studies comparing FICare (FICare group) with standard care (control group) for preterm infants in the NICU published between 2010 and 2024. The Cochrane risk-of-bias tool for randomized trials 2.0 and the Newcastle‒Ottawa Scale were used to assess study quality. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the quality of the outcomes. Clinical outcome data were synthesized through meta-analysis and systematic review. Comparisons are reported as pooled mean differences (MDs) or relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: A total of eleven studies (six RCTs and five cohort studies) including 4,951 preterm infants (2,507 in the FICare group and 2,444 in the control group) were eligible, and their methodological quality was acceptable. Quantitative analysis revealed that preterm infants in the FICare group had faster weight gain velocity (MD: 2.52 g/d, 95% CI: 0.12–4.92, P = 0.04), greater changes in the weight z score at 21 days (MD: 0.09, 95% CI: 0.05–0.13, P < 0.001), and higher breastmilk feeding rates (RR: 1.54, 95% CI: 1.15–2.06, P = 0.004) than did those in the control group. Studies used different assessment scales found that preterm infants receiving FICare had better neurodevelopment outcomes. In terms of the number of days with respiratory support, duration of oxygen therapy, time to full enteral feeding, late-onset sepsis rate, length of stay, and all-cause mortality rate, these two groups were comparable. Sensitivity and subgroup analyses and funnel plots with Egger’s tests suggested acceptable robustness and publication bias, supporting the results of the present study. CONCLUSIONS: Preterm infants exposed to FICare had better weight gain, breastmilk feeding, and neurodevelopment, but showed no significant improvement in clinical outcomes such as length of NICU stay, respiratory support, and full enteral feeds. REGISTRATION: This study has been registered on PROSPERO (CRD42022351436). CLINICAL TRIAL NUMBER: Not applicable.