Studio internazionale sulle pratiche della "care" nelle unità di terapia intensiva neonatale

Background. Developmental Care -an approach using a range of medical and nursing interventions aimed to decrease the stress of preterm neonates in Neonatal Intensive Care Units (NICUs)- have quite important effects on neonates health both in the short and medium-long run. Though, it is still not enough clear how and how frequently these procedures are used. Aims The present survey deals with forms and frequencies of use of Developmental Care in both Italian and European NICUs. Through comparable data, the survey takes into consideration the different aspects of structures and physical environment in which the Developmental Care is used, the concrete medical and nursing practices and the main obstacles in the diffusion of Care activities. Methods. A questionnaire was sent to 364 NICUs in Belgium, Denmark, France, UK, Italy, Netherlands, Spain and Sweden. The main sections of the questionnaire were the following: NICUs environment, neonate’s management, pain management, policies towards parental visiting. Frequency distribution, average value, median and relative confidence intervals, range and percentiles were computed by total population and by country. For Italy, a log-linear model has been applied in order to evaluate the association between the Developmental Care indicators and the NICUs’ main features (geographical location, unit’s level, dimension, affiliation to university). Results. The total response rate is 78% (100% in Denmark, Netherlands and Sweden and 70% in UK and Italy). The environment is controlled through a 24 hours moderate lighting in 59% of NICUs (80% in Netherlands, 44% in Spain). As for neonate’s management, the nesting is largely used in most countries (94% of NICUs). As for pain control, 58% of units use pharmacological analgesia during endotracheal intubation (94% in Denmark, 28% in Italy) and 50% of NICUs use non-pharmacological analgesia during lumbar puncture (94% in Denmark , 27% in Spain). Both Denmark and Sweden have unlimited parental visiting, when in Italy and Spain this is an opportunity offered only in respectively 33% and 27% of the cases. In Italy the most powerful factor influencing the differences in Developmental Care use is the geographical repartition. NICUs in Southern regions show, in terms of pharmacological (OR 0,36; IC 95% 0,13-0,98) and non- pharmacological (OR 0,34; IC 95% 0,11-0,99) analgesia, a lower attention to pain management than in the Northern areas. Southern Italy opens the department to parental visits much less than the rest of the country. In the first case, mothers are free to be by their child less frequently than in the North (South vs North OR = 0.29; IC 95% 0,10-0,87) and fathers less free to practice the kangaroo cares (South vs North OR=0.19; IC 95% 0,06-0,58). Conclusions. Many of the Developmental Care elements are presently consolidated in the medical and nursing practices of the European NUCUs. The areas in which a wider differentiation is shown is the pain management and the opening to parental visits. North European countries show a higher attention to these aspects than Italy and Spain and a similar North-South differentiation is also shown in Italian Developmental Care application.