Nurse-led family integrated care and time to first parent-infant holding in very preterm infants (< 32 weeks): a multi-site pre-post quasi-experimental study.

BACKGROUND: Preterm birth often leads to prolonged neonatal intensive care unit (NICU) stays and delays early parent-infant bonding. While Family Integrated Care (FICare) addresses these issues, the specific impact of a nurse-led FICare model on expediting first parent-infant holding in very preterm infants remains underexplored. AIM: This study evaluated a nurse-led FICare intervention to reduce the time to first parent-infant holding for very preterm infants (gestational age < 32 weeks) in the NICU. METHODS: Multi-site, nonrandomized pre-post (nonequivalent groups) Type 2 implementation-effectiveness hybrid across four Level III NICUs in Saudi Arabia. Study periods: pre (September 1, 2024-February 28, 2025) and post (April 16-August 31, 2025), separated by a 6-week wash-in (March 1-April 15, 2025); audits verified 0% NL-FICare exposure pre-intervention and ≥ 80% fidelity post-implementation. PRIMARY OUTCOME: time from birth to the first continuous parent-infant holding ≥ 20 min; infants without the event were censored at discharge/transfer/death or day 21. SECONDARY OUTCOMES: parental stress/anxiety and breastfeeding indicators. Analyses were intention-to-treat, using Kaplan-Meier, Cox models with site fixed effects (robust SEs), and restricted mean survival time. RESULTS: The median time to first holding decreased by 24.5 h, from 52.5 h (Brookmeyer-Crowley 95% CI 38.0-71.0) pre-intervention to 28.0 h (95% CI 20.5-38.5) post-intervention. Landmark Kaplan-Meier cumulative probabilities were higher post-intervention at 24 h (23.2% vs. 8.6%), 48 h (53.6% vs. 29.3%), 72 h (71.4% vs. 46.6%), and day 21 (91.1% vs. 79.3%). In adjusted Cox models, the rate of first holding was higher post-intervention (aHR = 1.62, 95% CI 1.08-2.43; p = 0.019). The restricted mean survival time (RMST) difference indicated 51.6 fewer hours without holding by day 21 post-intervention. Parental stress/anxiety decreased, and breastfeeding initiation/duration improved. CONCLUSIONS: A nurse-led FICare intervention was associated with earlier first parent-infant holding and more favourable parental and breastfeeding outcomes in very preterm infants. Given the quasi-experimental design, findings should be interpreted as associative rather than causal, and replication in adequately powered randomised trials is warranted. IMPLICATIONS FOR NURSING: The findings support integrating nurse-driven FICare strategies into routine NICU practice to advance family-centered care and optimize parent-infant contact. CLINICAL TRIAL NUMBER: Not Applicable.