Feasibility of an Expanded Holding Protocol for the NICU.

OBJECTIVE

To develop and evaluate the feasibility of an expanded holding protocol designed to increase opportunities for parent-infant physical contact in the NICU.

DESIGN

Quality improvement feasibility study using a pre-post implementation design.

SETTING

Level IV NICU at the Montreal Children's Hospital.

PATIENTS/

PARTICIPANTS

We applied the protocol to all infants admitted to the NICU. Outcome analyses included infants captured in a routinely collected data set submitted to the Montreal Regional Public Health Department.

INTERVENTIONS: A multidisciplinary team developed a five-category holding protocol that expanded eligibility for skin-to-skin care and introduced additional methods of holding based on each infant's clinical status. The team introduced the protocol in April 2024 and supported its introduction through multidisciplinary, simulation-based education.

MAIN OUTCOME MEASURES: Holding among newly eligible infants, proportion of infants with documented holding during admission, and timing of first documented holding.

RESULTS

The expanded eligibility criteria made an additional 80 infants eligible for holding, and 26 (33%) of these infants had a documented holding episode. Documented holding increased from 71% (288/404) before introduction to 80% (365/454) after introduction (p = .002). The median day of first documented holding increased from 1 to 2 days of life (p < .001).

CONCLUSION

The expanded holding protocol broadened eligibility for parent-infant physical contact and coincided with an increase in documented holding in the NICU. However, only one-third of newly eligible infants had a documented holding episode, which highlighted the need to address barriers to holding in addition to expanding eligibility.