Research shows that preemie babies do better when families are involved in care

Dr. Karel O’Brien, with mother, Amy, whose twins were born at 23 weeks, 5 days.

An international study led by Sinai Health System researchers shows that a Family Integrated Care model of treating the tiniest and most fragile babies helps improve the wellbeing of both children and parents.

Neonatal intensive care units (NICU) in Canada, Australia and New Zealand adopted the Family Integrated Care model, developed at Mount Sinai Hospital by Dr. Shoo Lee, and found that it improved the wellbeing of both preemie babies and their parents compared to standard care:

  • Improved weight gain among preterm infants
  • Better breastfeeding
  • Reduced parental stress and anxiety

When Amy, a new mother of twins found herself in the Mount Sinai NICU with babies born at 23 weeks and 5 days, she felt scared and overwhelmed by how fragile the babies were. Still in the NICU after almost three months, she has found comfort in being part of the Family Integrated Care model. “It really allowed me to feel like a mother. Being with my babies all day, I know instinctively if something is wrong or what they need, and can report that to the doctors and nurses. They are getting stronger and stronger every day, and this model of care has made me believe that when I bring them home, I’ll be able to confidently care for them.”

The study was led by Mount Sinai Hospital researchers Dr. Karel O’Brien, neonatologist, and Dr. Shoo Lee, Chief of Pediatrics. Recently published in the prestigious journal, The Lancet Child & Adolescent Health, it involved nearly 1,800 infants born at 33 weeks gestation or earlier across 26 NICU units.

What is Family Integrated Care?

Family Integrated Care actively involves parents in the care of their newborns, including giving oral medicine, feeding, taking their temperate and taking part in ward rounds.

Mount Sinai supports parents in spending six hours a day, at least five days a week with their babies by providing them with a rest space and sleeping room, comfortable reclining chairs at the bedside and nurses trained in family support.

“Parents are too often perceived as visitors to the intensive care unit. Our findings challenge this approach and show the benefits to both infants and their families of incorporating parents as key members of the infant’s health care team, and helping parents to assume the role of primary caregiver as soon as possible,” says Dr. Karel O’Brien, who leads the Family Integrated Care Program at Mount Sinai.

Real impact for preemies and parents

“How care is provided to the family, not just the infant, has a positive effect on the wellbeing of both infant and family,” says Dr O’Brien. “Weight gain, breastfeeding and reduced parental stress and anxiety are all associated with positive neurodevelopmental outcomes, suggesting that integrating parents into the care of infants at this early stage could potentially have longer-term benefits.”

At 21 days, infants in the Family Integrated Care group had put on more weight and had higher average daily weight gain (26.7g vs 24.8g), compared to the standard care group. Additionally, parents in the Family Integrated Care group had lower levels of stress and anxiety, compared to the standard care group. Once discharged, mothers were more likely to breastfeed frequently (more than 6 feeds a day), compared to the standard care group (70% vs 63% ).There were no differences in rates of mortality, duration of oxygen therapy or hospital stay.

“The results of this trial are encouraging indeed. Not only is this an example of innovative care developed here in our hospital, it is an exceptional example of how a good idea can be shared across the country and around the world,” says Dr. Lee.  “This was truly a collaborative effort with participating NICU’s, parents, and the whole care team.”

Read more about this story in the media.

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Sinai Health System is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Look for other RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

Health & Community Leaders Talk: Jim Woodgett

By Jim Woodgett, Director of Research at the Lunenfeld-Tanenbaum Research Institute, part of Sinai Health System

Jim Woodgett

What does health research mean to you?

Health research is a spectrum, from making new and amazing discoveries through to identifying the best ways to implement best practices in delivery of care. We tend to see the delivery side of the pipe and forget that we have so much more to learn – about our biology, our susceptibilities, what most of our genes do (we are largely still in the dark), how diseases are caused, what might prevent them….  So many questions! Luckily for me in my job, I do get to see the whole pipeline – from new understandings of how worms move (which helps us understand diseases like Parkinson’s), to new therapeutics that we’ve helped develop and may be tested on our patients through to identifying new risk factors and ways to avoid exposures. There is a lot going on but there is always so much more to do. Our scientific ignorance is the biggest gap in achieving better quality of life

How does health research contribute to a healthier, wealthier, smarter Ontario?

The question is really, why Ontario? Why can’t we just let some other country develop better ways to provide care and we can then adopt them? Well, we could and we’d always be a few years behind. We’d never have control (of price, of coverage, of problems specific to Ontario). We’d yearn for our kids to visit as they moved to other parts of the world to make a difference. We’d fondly remember the world-class care we used to receive because the best physicians wanted to train here and improve the outcomes of their patients, here. We’d say goodbye to the burgeoning companies that pop up and grow in Ontario because we have a strong health research sector. We’d also lose our desire to make not only our own lives better, but also the lives of those so much less fortunate than Ontarians. That’s why.

 

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Read more Health and Community Leaders Talk blog posts on our Healthier, Wealthier, Smarter site and share your insights on Twitter with the hashtag, #onHWS. To learn more about how health research makes Ontario healthier, wealthier, and smarter, check out our website and our other blog posts and videos.

Research Spotlight: Sinai Health System

Short-term insulin therapy successfully induces remission in Type 2 diabetes

A new study lead by researchers at Mount Sinai Hospital, part of Sinai Health System, has shown that early intervention with short-term intensive insulin therapy for four weeks can successfully induce a remission of Type 2 diabetes that lasts for up to one year thereafter.

The study was led by Dr. Ravi Retnakaran, an endocrinologist with Leadership Sinai Centre for Diabetes at Mount Sinai Hospital, and has just been published in BMJ Open Diabetes Research and Care. The findings of Dr. Retnakaran and his team show that the earlier that short-term intensive insulin therapy was administered after the diagnosis of diabetes, the more successful it was in sustaining a 48 week remission.

Dr. Ravi Retnakaran, Mount Sinai Hospital
Dr. Ravi Retnakaran, endocrinologist with Leadership Sinai Centre for Diabetes at Mount Sinai Hospital

Short-term intensive insulin therapy is typically administered for a period of two to four weeks and can decrease insulin resistance, reduce glucagonemia, improve pancreatic beta-cell function and induce a remission that can last up to one year in just under 50% of patients. The study showed that those who had been diagnosed within the preceding two years and then undergone the treatment had the longest sustained remission. Patients who had sustained remission had better baseline beta-cell function that was preserved across the one year after stopping the treatment.

On the road to longer term remission

“This study points us in a very important direction in our quest to address one of the most prevalent chronic diseases today. The first point is the clear benefit of short-term intensive insulin therapy, and the second is the importance of early intervention within the first few years after diagnosis.   Our quest is to better understand the factors that determine remission so that we can offer long term solutions for our patients. The current study tells us that one key factor is early intervention with short-term insulin therapy during a window of opportunity that only exists in the first few years after diagnosis,” said Dr. Retnakaran.

Home to world-class diabetes researchers and research centres

Dr. Retnakaran, an endocrinologist with Leadership Sinai Centre for Diabetes at Mount Sinai Hospital and an investigator with the Lunenfeld-Tanenbaum Research Institute, collaborated with Drs. Bernard Zinman and Caroline K. Kramer, both of Leadership Sinai Centre for Diabetes at Mount Sinai Hospital and Lunenfeld-Tanenbaum Research Institute, in conducting a major clinical trial known as RESET-IT that aims to induce remission of Type 2 diabetes. The institute ranks amongst the top diabetes research centres in the world.

More than three million Canadians have Type 2 diabetes and the World Health Organization recently warned that rates have quadrupled since 1980, with 422 million people worldwide living with diabetes. The rate is expected to double in the next 20 years.

Patients interested in participating in the RESET IT trial should contact: Ms. Haysook Choi at Mount Sinai Hospital at (416) 586-8778 or haysook.choi@sinaihealthsystem.ca.

 

Sinai Health System is one of Ontario’s 24 research hospitals that contribute to a healthier, wealthier, smarter province. Look for other RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.