PC1072: Balancing Life Inside and Outside the NICU: Family Visitation for Extremely and Very Preterm Infants

Background: Family presence in the neonatal ICU (NICU) is central to family-centered care, a best practice associated with improved infant developmental and health outcomes, breastfeeding success, infant-parent bonding, and decreased length of stay (LOS). To be present, families must balance numerous personal, family, and job-related responsibilities, but data linking these factors and family presence is limited. This study examines family member visitation and the extent that infant, maternal, and social factors are associated with family presence.

Methods: We conducted a retrospective cohort study of infants born ≤32 weeks’ gestational age, cared for ≥1 week at 2 urban NICUs 1/2019 - 3/2020. We collected data on nurse-documented family member presence, mother and infant characteristics, and social factors from infants’ electronic health records. We identified overall average documented visit rates for mothers, fathers, and grandparents using mixed effects Poisson regression. To explore visitation trends, we used these average weekly visit rates and Latent Growth Modeling to identify two groupings of visit patterns across LOS for each family member: (1) below, at, or above average weekly visit rates, and (2) weekly visit rates that remained steady, increased, or decreased over hospitalization. We assessed associations of infant, maternal, and social factors with these visit patterns with unadjusted linear, multinomial, and logistic regressions with robust standard errors.

Results: Our criteria resulted in 167 infants with 147 mothers. Average documented weekly visit rates varied by family member: 4.4 days/week for mothers, 2.6 days/week for fathers, and 0.4 days/week for grandparents. Average visits rates on weekends did not differ significantly from weekdays nor did nighttime compared to daytime. (Figure 1). Table 1 shows factors associated with visitation patterns for each family member type. Maternal visit rates that were below average and that decreased over LOS were associated with lower infant birthweight, longer LOS, younger maternal age, and maternal history of depression and anxiety. Above average mother visit rates were seen for infants at 1 of the 2 NICUs and for mothers who lived in the same city as the hospital. Below average father visit rates were associated with maternal history of depression and public maternal insurance, while above average visit rates were associated with higher infant birthweight and shorter LOS. Above average grandparent visit rates were associated with maternal nulliparity.

Conclusion: These data enrich our understanding of NICU family visitation and potential barriers families may encounter. We found visitation differs by family member, with mothers visiting most frequently, but no significant differences according to day/night or weekend/weekdays. We demonstrate novel findings that several infant, maternal, and social factors are associated with below or above average visitation and visitation changes over the LOS. The next step is to learn from family members as to how these identified, meaningful factors impact their presence.