New Study shows how Family Integrated Care Reduces Mothers' Stress in the NICU

Findings from Evaluating the effect of Family Integrated Care on maternal stress and anxiety in neonatal intensive care units are described by the author and PTBi researcher, Linda Franck. Additional authors include Chelsea Cheng, Xiang Y. Ye, Sarah A. Hutchinson, Shoo K. Lee & Karel O’Brien on behalf of the FICare Study Group and FICare Parent Advisory Board.


Parents with infants in a neonatal intensive care unit (NICU) often have increased stress, anxiety, and depression, not only because of their infants’ prematurity or other medical conditions but also because of the complex and technological NICU environment and prolonged physical separation. These factors all contribute to parent stress, which is known to negatively impact infant behavior and other long-term outcomes. 

The Family Integrated Care (FICare) model of NICU care was designed to eliminate barriers between parents and their infants by incorporating parents as partners in their infant’s NICU care. In FICare, parents are supported to work in partnership with the healthcare team and, over time, to perform all of their infant’s care in the NICU with the exception of ventilation, adjustment of monitor settings, and administration of IV fluids and medications (excerpt taken from Cheng et al., 2019).

Please describe your research findings.

In the landmark trial of Family Integrated Care (FICare), it was reported that mothers of preterm infants (born 33 weeks or less) cared for in NICUs that implemented the FICare model reported significantly less NICU-related stress and anxiety than mothers in NICUs that practiced standard Family-Centered Care (FCC). In this analysis, we examined in more detail how FICare affected the different dimensions of NICU-related stress and anxiety so we could better understand the impact of the FICare program.

We found that the mothers who participated in FICare experienced less total stress than the mothers who participated in FCC over a 21-day period. The greatest decrease in stress was seen in the dimension of parental role, meaning that the FICare mothers felt their level of involvement in their baby’s care was more similar to parents of healthy babies.

Our results suggest that FICare could be used to improve mental health outcomes for mothers of moderately ill preterm babies in the NICU.

Linda Franck, Contributing Author

Principal Investigator, mFICare study, evaluating mobile-enhanced FICare in 5 California NICUs

Are there any “first(s),” “biggest(s),  or “only(s)” with this study – i.e., first study to quantify or examine something, the largest study of its kind, etc.?  

To our knowledge, this study is the largest multi-site, multi-country investigation of NICU-related maternal stress and anxiety, and the effects of FCC and FICare.

What is already known about this topic, and how do your findings add to or change this existing knowledge?

Many NICU interventions have reported that parent education, psychological support, and participation in rounds can all have a positive impact on reducing maternal stress and anxiety but these interventions are rarely studied in high quality randomized clinical trials or in combination. Our findings show that FICare is effective at reducing maternal stress and anxiety in the NICU environment, particularly by reducing parental role stress and anxiety. We also have a deeper understanding of the relationships among the dimensions of NICU-related parental stress and anxiety to guide future research.

How does your research impact current clinical practice? How does your research impact patients?

FICare is a comprehensive approach that is effective at targeting all dimensions of maternal stress and anxiety in the NICU. Our results suggest that FICare could be used to improve mental health outcomes for mothers of moderately ill preterm babies in the NICU.

What should researchers/providers/patients/public health workers/etc. do as a result of these findings?

More research should be conducted to assess the effects of FICare on fathers as well as mothers and the long-term effects on both parents and infants.

Read the full paper

Evaluating the effect of Family Integrated Care on maternal stress and anxiety in neonatal intensive care units

Learn More About mobile-enhanced FICare (mFICare)