title: Breaking down barriers: enabling care-by-parent in neonatal intensive care units in China.
abstract: BACKGROUND
  Denying parents access to their infant in the Neonatal Intensive Care Unit (NICU) is a standard practice in most hospitals across China. Visitation is not usually permitted or may be strictly limited, and NICU care for most neonates is provided by health-care professionals with little participation of the parents. An exception to this rule is the level 2 "Room-In" ward in Qilu Children's Hospital, Shandong University, where parents have 24-hour access to their infants and participate in providing care.
  
  
  METHODS
  This retrospective cohort study compared the outcomes of infants who were admitted to the NICU and remained there throughout their stay (NICU-NICU group, n=428), admitted to the NICU and then transferred to the Room-In ward (NICU-RIn group, n=1018), or admitted straight to the Room-In ward (RIn only group, n=629).
  
  
  RESULTS
  There were no significant differences in the rates of nosocomial infection, bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity between the NICU-NICU and NICU-RIn groups. The rate of necrotizing enterocolitis was significantly lower in the NICU-RIn group (P=0.04), while weight gain and duration of hospital stay were significantly higher (both P<0.001). Rates of adverse outcomes were lower in RIn-only infants due to their low severity of illness on admission.
  
  
  CONCLUSIONS
  Allowing parents access to their infant in the NICU is feasible and safe in China, and may result in improvements in infant outcomes. Further studies are required to generate stronger evidence that can inform changes to neonatal care in China.
authors.affiliation: Neonatalogy Department, Qilu Children's Hospital Shandong University, Jinan, China.
authors.forename: Xiao-Ying
authors.initials: XY
authors.lastname: Li
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.|Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shoo
authors.initials: S
authors.lastname: Lee
authors.affiliation: Neonatalogy Department, Qilu Children's Hospital Shandong University, Jinan, China.
authors.forename: Hua-Feng
authors.initials: HF
authors.lastname: Yu
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Xiang Y
authors.initials: XY
authors.lastname: Ye
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Warre
authors.affiliation: Neonatalogy Department, Qilu Children's Hospital Shandong University, Jinan, China.
authors.forename: Xiang-Hong
authors.initials: XH
authors.lastname: Liu
authors.affiliation: Neonatalogy Department, Qilu Children's Hospital Shandong University, Jinan, China. etyyljh@126.com.|, No. 23976, Jingshi Road, Jinan, Shandong, China. etyyljh@126.com.
authors.forename: Jian-Hong
authors.initials: JH
authors.lastname: Liu
mesh_terms: D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D012016:Reference Values; D012189:Retrospective Studies; D014789:Visitors to Patients / Q000523:psychology*
keywords: care-by-parent; family-centered care; infant; neonatal intensive care unit; newborn; parental involvement