“Before I go to sleep, I quickly check on my son. When I see him lying there so peacefully, it calms me down.” – Parent statement

Family separation in the NICU

Newborns with special care needs, especially preterm infants and those born with congenital malformations or complications, are usually cared for in neonatal intensive care units (NICUs), often for extended periods of time. Many parents struggle with feelings of guilt or anxiety when leaving their newborn in the NICU to go home to work or deal with other family matters. What is more, extended separation of parents and baby can gravely impact attachment and bonding processes. It has also been shown to negatively affect breastfeeding and breastmilk feeding rates.

To support parents in this challenging situation, some hospitals have started to offer parents the option to install a webcam over their baby’s cot which provides a continuous live video stream. So far, however, the impact has not been studied in a systematic manner neither on a national nor an international level. Moreover, little educational material exists to help medical staff and families use the technology in a beneficial manner. In fact, just like healthcare professionals, parents rarely receive proper information and training regarding the usage of webcams in NICUs.

The research project

Between 2019 and 2023, the Neo-CamCare project, led by the University of Cologne, Germany, conducted a systematic study of the benefits of webcams in German NICUs from the perspectives of parents and caregivers. The project also systematically identified previously unconsidered aspects, such as legal and data protection issues. Its aim was to assess and evaluate the benefits of webcams in NICUs while also developing an action guide for hospitals and incorporating feedback from parents and families.

Families were eligible to participate in the study if

• their child was born during the study period, i.e. between December 2019 and July 2022,
• the child weighed less than 1,500 g at birth, and
• the child received treatment in one of the participating NICUs.

Families participated for a period of two months in the study unless they were discharged earlier. To understand and analyse the effect of webcams, families spent one month in the NICU without access to a webcam and a second month with access to one. A total of 460 families participated in the study.

Importantly, the cameras were set up to only provide a live video stream – no sound was available, and the cameras did not record and save any data. The transmitted images were encoded. Personal and private information, for example on monitors, was protected to avoid accidental transmission via the webcam. Parents received a personal login and were the only ones able to access the stream. Medical staff had the ability to switch the cameras off, e.g. during certain care or treatment routines.

The study team interviewed both parents and medical staff to learn about their concerns, expectations, and experiences. Researchers also accompanied medical staff during their shifts to analyse how the webcams impacted the execution of individual tasks as well as the workload more generally.

Positive feedback from parents and medical staff alike despite mixed results

© Kathy’s Knipskiste

The feedback from parents clearly showed that most of them rated the webcams as helpful and that they felt more connected to their child, although the study did not find evidence of increased attachment rates. Parents generally reported feeling less anxious and stressed. Additionally, live video footage of their baby significantly increased mothers’ lactation rates and milk flow when expressing milk at home.

Nevertheless, the interviews also revealed that the webcams could potentially become a source of additional stress. Some parents reported feeling anxious when discovering that the camera had been turned off during a routine care procedure. Others admitted to struggling with logging out and resting or dealing with other tasks.

Nursing staff also recorded positive responses to the webcams. For instance, 83% of them did not perceive the use of webcams as adding to their workload during already very busy shifts. No clear indications were found that the webcams interrupted the nursing staff’s workflow or impaired their work performance. Parents’ preference for using a webcam was also not related to their level of trust in the staff’s ability to care for their child.

Rather, as the data show, medical staff viewed the webcams as useful additional means of communicating with families as well as a tool to further strengthen the bond between parents and baby. Data also showed, however, that parents stayed for a shorter period in the NICU when a webcam was available. The overall frequency of visits remained stable.

In conclusion, the implementation of webcams in NICUs could further improve the way parents connect with their newborns in the NICU, offering peace of mind while also enhancing communication and connection. Parents and medical staff need proper training, however, to handle the technology in beneficial and healthy ways. EFCNI and its German partner parent organisation “Das frühgeborene Kind” (“The preterm child”) supported the project.

Read more about the project in German: https://www.neocamcare.uni-koeln.de/