FAMILY CARE FOR PRETERM INFANTS AT HOME: INTERFACES WITH THE NURTURING CARE FRAMEWORKABSTRACT
Objective: To understand the interfaces of family care for preterm infants at home with the domains of good health, adequate nutrition, responsive care, safety and protection, and early learning opportunities, from the Nurturing Care Framework (NCF).
Method: This is a qualitative study guided by the theoretical framework of Nurturing Care Framework. Data were collected between August 2023 and March 2024, in the homes of 12 preterm infants, with 27 family members, followed by a high-risk newborn follow-up service. During the visits, dyadic or group family interviews were conducted, and records were kept in field diaries. In parallel, two researchers performed blind coding of the data and inter-coder verification, using software-assisted deductive thematic analysis guided by a code dictionary.
Results: The results showed: prevention of illness and promotion of physical health in preterm infants; early introduction of solid foods and breastfeeding-related weaknesses; caregiver responsiveness to the needs of preterm infants; intrafamily safety and prevention of domestic accidents; Early learning opportunities, limited to motor stimulation.
Conclusion: It became evident that caregivers have a limited understanding of the domains of Nurturing Care Framework (NCF), a reflection of the current healthcare model in the research setting. It is expected that families, upon receiving nursing care and guidance based on the NCF, will be able to broaden their understanding and applicability of the model in their daily lives, which would be aligned with the objectives for sustainable development.
DESCRIPTORS:
Transitional care; Child development; Early intervention; Family; Preterm newborn; Child health
RESUMO
Objetivo: Compreender as interfaces do cuidado familiar ao pré-termo no domicílio com os domínios de boa saúde, nutrição adequada, cuidados responsivos, segurança e proteção e oportunidades de aprendizagem precoce, do Nurturing Care Framework.
Método: estudo qualitativo orientado pelo referencial teórico do Nurturing Care Framework. Os dados foram coletados entre agosto de 2023 e março de 2024, nos domicílios de 12 pré-termos, com 27 familiares, acompanhados por um serviço de seguimento de neonatos de risco. Durante as visitas, realizou-se entrevista familiar diádica ou em grupo, e registros em diários de campo. Paralelamente, duas pesquisadoras realizaram codificação às cegas dos dados e verificação intercodificadores, por meio de análise temática dedutiva apoiada por software e orientada por um dicionário de códigos.
Resultados: Os resultados evidenciaram: Prevenção de adoecimento e promoção da saúde física do pré-termo; Introdução alimentar precoce e fragilidades relativas ao aleitamento materno; Responsividade dos cuidadores às demandas do pré-termo; Segurança intrafamiliar e prevenção de acidentes domésticos; Oportunidades de aprendizagem precoce, limitadas à estimulação motora.
Conclusão: Ficou evidente que os cuidadores apresentam uma compreensão restrita dos domínios do Nurturing Care Framework, reflexo do modelo assistencial de saúde vigente no cenário de investigação. Espera-se que as famílias, ao receberem cuidados e orientações de enfermagem, baseados no NCF, possam ampliar a compreensão e aplicabilidade do modelo em seu cotidiano, o que estaria alinhado aos objetivos para o desenvolvimento sustentável.
DESCRITORES:
Cuidados de transição; Desenvolvimento infantil; Intervenção precoce; Família; Recém-nascido pré-termo; Saúde da criança
RESUMEN
Objetivo: Comprender las interfaces del cuidado familiar de los bebés prematuros en el hogar con los ámbitos de la buena salud, la nutrición adecuada, la atención receptiva, la seguridad y la protección, y las oportunidades de aprendizaje temprano, del Nurturing Care Framework (Marco de atención integral).
Método: estudio cualitativo guiado por el marco teórico del Nurturing Care Framework. Los datos se recogieron entre agosto de 2023 y marzo de 2024 en los hogares de 12 bebés prematuros, con 27 miembros de su familia, seguidos de un servicio de seguimiento de recién nacidos de alto riesgo. Durante las visitas, se realizaron entrevistas familiares, tanto individuales como grupales, y se tomaron notas en diarios de campo. Paralelamente, dos investigadoras realizaron una codificación ciega de los datos y una verificación entre codificadores, utilizando un análisis temático deductivo apoyado por software y guiados por un diccionario de códigos.
Resultados: Los resultados mostraron: Prevención de enfermedades y promoción de la salud física en bebés prematuros; Introducción temprana de alimentos sólidos y vulnerabilidades relacionadas con la lactancia materna; Capacidad de respuesta del cuidador a las necesidades de los bebés prematuros; Seguridad intrafamiliar y prevención de accidentes domésticos; Oportunidades de aprendizaje temprano, limitadas a la estimulación motora.
Conclusión: Se hizo evidente que los cuidadores tienen una comprensión limitada de los dominios del Nurturing Care Framework, un reflejo del modelo actual de atención médica en el ámbito de la investigación. Se espera que las familias, al recibir atención y orientación de enfermería basadas en el NCF, puedan ampliar su comprensión y la aplicabilidad del modelo en su vida diaria, lo que estaría en consonancia con los objetivos de desarrollo sostenible.
DESCRIPTORES:
Atención de transición; Desarrollo infantil; Intervención temprana; Familia; Recién nacido prematuro; Salud infantil
INTRODUCTION
In Brazil, in 2024, approximately 12.3% of all live births were preterm, meaning they were born before completing 37 weeks of gestational age, and a similar trend was observed in the state of Minas Gerais1. Prematurity is one of the main threats to early childhood development due to its high correlation with infant morbidity and mortality2. In addition, caregivers may experience considerable challenges in providing comprehensive care to preterm infants at home3-5. This care requires adequate environmental conditions that promote health, nutrition, safety, protection, responsive care, and learning opportunities from the beginning of life4-5.
This is what the strategic plan Nurturing Care Framework (NCF)4-5 advocates. This model was proposed by the World Health Organization (WHO), in conjunction with the United Nations Children's Fund (UNICEF), in line with the Sustainable Development Goals (SDGs)4-6. The NCF invites different sectors of society, especially the health sector, to promote early childhood development4,5,7. According to the model, healthcare professionals are in a privileged position to support comprehensive care, since families and children have greater access to these services from pregnancy up to three years of age4,5,7. Therefore, these professionals should provide information and guidance to caregivers and support families, especially those of babies with perinatal complications4,5,7.
The literature points to national and international studies that use the NCF as a reference, and presents its contribution to public policies focused on the SDGs and early childhood health care8-10. However, no studies addressing NCF in the home context of preterm infants and their families were found. We start from the premise that the experiences of family members in caring for preterm infants at home have interfaces with what is advocated by the NCF. However, there are limitations experienced in the home setting of preterm infants that have to be explored, so that strategies allowing for a more comprehensive consideration of the dimensions of this care model are proposed. Therefore, the question that arises is: how do family care experiences for preterm infants at home interface with the domains of good health, adequate nutrition, safety and protection, responsive care, and early learning opportunities, as outlined in the NCF?
The aim of this research was to understand the caregiving experiences of family members for preterm infants at home and their interfaces with the NCF. This research is justified because a study highlighting functional aspects in the experience of families on this journey can guide the management and care of the needs of preterm infants for managers, public policy makers, healthcare professionals, and families.
METHOD
Qualitative study11 guided by the theoretical framework of the NCF4-5. It was approved by the Ethics Committee of the proposing institution. The eligibility of participants was determined through review of the preterm infant's medical record, monitored by the Advanced Early Intervention Program (PIPA) outpatient clinic12, with the support of a script developed by the researchers. PIPA is a follow-up service for at-risk newborns established by the state government and provided by the Brazilian Public Health System (SUS) in a city in the Central-West region of Minas Gerais12. More than half of the services provided by this program are for children born prematurely. Follow-up care for at-risk newborns is conducted quarterly by a multidisciplinary health and social care team until the infant reaches 24 months of chronological age12.
The inclusion criteria for participants were: families of preterm infants residing in the municipality and served by PIPA, with a corrected age between 5 and 7 months, without a diagnosis in addition to prematurity of confirmed or suspected congenital disability and/or anomaly. A caregiver diagnosed with an intellectual disability, which would prevent them from understanding the questions, was adopted as an exclusion criterion. Fifty-eight medical records were analyzed, and 32 eligible preterm infants were identified, whose primary caregiver (father or mother) was contacted by phone or in person at the PIPA outpatient clinic. Of these, 14 refused, six did not respond to the phone call, and 12 agreed to participate. At the time of acceptance, the primary caregiver was asked which family members participated daily in the care of the premature infant. Given this, it was proposed that these caregivers be invited to participate in the data collection process, which would take place during the home visit. The visit was scheduled based on the simultaneous availability of the caregivers in question. Twenty-seven family members (12 mothers, six fathers, six grandmothers, two grandfathers, and one aunt) of preterm infants participated in this study.
Data were collected from the households of 12 preterm infants between August 2023 and March 2024. The home visits were conducted by a researcher, with the participation of two undergraduate students (nursing and medicine). The researcher, a master's student in a postgraduate nursing program with experience in caring for at-risk newborns and their families at the PIPA service, received training, supervision, and guidance from another more experienced researcher. A semi-structured instrument developed by the authors was adopted, which included questions based on the NCF and characterization of family members and preterm infants4-5, for dyadic or group family interviews13. The interviews were conducted by the researcher and recorded using two audio recorders. Personal impressions and observations about the home environment were recorded in a field diary11. The average time spent in households was one hour and fifty-two minutes.
To identify the appropriate time to stop conducting new interviews, an analysis process was carried out concurrently with data collection. In view of this, data theoretical saturation was identified with the 11th family and confirmed on the 12th14. The entire process was shared among three researchers and conducted in four stages: creation and validation of the code dictionary; concordance analysis based on inter-coder validation; coding of the interviews; and presentation of the results. The transcribed interviews were subjected to deductive thematic analysis15, supported by MAXQDA software, 2024 version16. The interviews, despite being transcribed in full, were not presented to the families for validation. To ensure confidentiality and anonymity, each preterm infant and their family were identified by their degree of kinship with the child, followed by the interview number. For example, in the first interview, the preterm infant was identified as “P1”, the family as “Family 1”, and the mother as “Mother P1”, and so on. The authors declare that they did not use any artificial intelligence tools, models, or services during the preparation of this article. The results are presented and organized into five categories.
RESULTS
Regarding the characteristics of the parents of preterm infants: their ages ranged from 22 to 44 years, and their level of education ranged from unfinished primary education to a completed doctorate degree. The gestational age at birth of preterm infants ranged from 29 weeks and one day to 36 weeks.
Content analysis revealed the following categories: (1) Prevention of illness and promotion of physical health of the preterm infant; (2) Early introduction of food and breastfeeding-related weaknesses; (3) Responsiveness of caregivers to the demands of the preterm infant; (4) Intrafamily safety and prevention of domestic accidents; (5) Early learning opportunities, limited to motor stimulation.
Preterm infants illness prevention and physical health promotion
The respondents considered the preterm infants to be healthy. This perception was related to the absence of disease, comparison with full-term newborns, and the perception of good growth and development, even when illnesses or health problems arose. The analysis also highlighted the understanding of family members themselves regarding their health, associated with routine check-ups, physical exercise, and dietary habits:
His health (referring to P11) is good, thank God, very good! […] It was only his throat that had that plaque on it, right? As I mentioned... well, now, thank God, everything's fine now, nothing else has happened. […] (Mother P11).
[…] But in terms of health, no illnesses, right, love? (referring to father P7)?! (Mother P7) None! I think the point that demands the most attention is eating habits themselves (referring to the parents' diet 7) (Father P7).
The analysis indicates that family care includes identifying and addressing the preterm infant’s health needs. Families are concerned about illness, and consequently, they seek preventive measures and pay attention to signs and symptoms. For this reason, families seek support from health services and professionals:
Just like the day he (referring to P2) turned purple with me here, and I thought, 'No, my son is dying.' Then I went to the UPA (Emergency Care Unit), tests were done, the electrocardiogram of his little heart showed that he has a heart murmur because he was premature (Mother P2).
Early solid foods introduction and breastfeeding-related weaknesses
According to the analysis, the feeding trajectories of the preterm infants proved to be unique. At the time of fieldwork, all of them, except P4, were already on complementary feeding, with eight of them starting this process between 4 and 5 months of corrected age (P1, P2, P5, P6, P7, P8, P9, P12) (Figure 1). The foods offered are shown in Figure 2. Fruits of varying qualities were unanimously mentioned by the families and offered mainly at the beginning of the process. Yogurt was mentioned by family 5, even though it was advised against by a healthcare professional, as stated below.
It's yogurt that the doctor (referring to pediatrician) thought I shouldn't give it, but she (refers to P5) manages to take it and we give it anyway ... it's normal upbringing. (Maternal grandfather P5).
Only family 12 stated that the introduction of solid foods was started without the approval of a healthcare professional. Related to this, a divergence in guidelines was observed. According to the mother of preterm 1, the introduction of solid foods was recommended by the private pediatrician and the nurse from the Family Health Strategy (FHS), but contraindicated by the neuropediatrician.
Because of her age...it's the same with food, the pediatrician said we had to wait until she was nine months old, right? (Maternal grandmother P12) No, we had to wait for him. (referring to P12) to sit. (Mother P12) […] Yes, to become more stable. But you see […] In January I already started wanting to add a little bit of bean broth, he (referring to P12) has already accepted the bean broth quite well (Maternal grandmother P12).
Because it has…like I say: 'There are a lot of people following P1 and a lot of people have... tell me something.' […]'. So much so that on the day I took […] Then the pediatrician in the morning says, 'He can eat,' and the neuropediatrician in the afternoon says, 'Don't give him food.' […] then I said: 'I'm going to get everyone together and say: you guys come to a consensus and tell me' (Mother P1).
In this study, four families mentioned challenges in introducing solid foods, which they were still experiencing (P1, P5, P11) or which had already been overcome (P12). Among them are food refusal, selectivity, and regurgitation. Consequently, the acceptance of the food or the amount of milk consumed per day indicated a positive perception of nutrition. The consumption of fruits, vegetables, and legumes was linked to a healthy family diet. Intrafamily differences regarding eating habits were also identified.
[…] The food was terrible…It was difficult for him. (referring to P1) She's breastfeeding, right? But his introduction (referring to P1) has been a disaster. […] Fruit, mashed up and all that…he wouldn't accept anything…nothing. (Mother P1).
Well, I think I'm easygoing, that I eat everything. Now, Father P9, he's less of a fruit person, right, Father P9? (Mother P9) Yes… (Father P9).
Caregiver responsiveness to the preterm infants demands
All families reported identifying the preterm infant's behaviors in response to their care needs. These demands are related to hygiene, nutrition, sleep, and health. For some families, stimulating their development was also considered a need for care, carried out at specific times of the day with targeted activities, or during routine actions, such as bath time and feeding. Furthermore, the analysis showed that establishing a routine is identified as relevant for some families, but not for others.
And everything is so perfect, because it's like I tell Mom P10, like he... (referring to P10) shows us, it's... demonstrate it, it's... like this, sleep, 'I want to sleep, I don't want to play, I don't want anything else here' (Maternal grandmother P10).
Yes...and the stimuli, right? (Mother P7) That's exactly it, the stimuli… (Father P7) […] Which is something we do more often, you know? Always try to do it with him (referring to P7), you know? More times a day (Mother P7).
Like I said, P1 doesn't have a basic routine, like waking up, sleeping, feeding... no, P1 creates his own routine. Because...we're not really the type to have much of a routine like that (referring to family 1) (Mother P1).
The analysis revealed the presence of affectionate care provided to the premature infant by the families. The frequency of these care visits varied for each family, especially because during some visits the preterm infants remained asleep most of the time, as was the case with preterm infants 5, 7, and 11. These acts of care were perceived through affectionate caresses and words, and recorded in a field diary.
SHORT BREAK - Everyone (referring to family 3) stops to observe again and interact with P3, who babbles in response and is happy. She goes back to the ground and starts crawling, her father says 'now run, run!', her grandmother says 'go, show the lady (referring to the researcher) that you know how to run'. Everyone laughs and watches P3 with affection. (Field diary, Family 3, Interviewer 1).
Intrafamily safety and domestic accidents prevention
For most families, the safety and protection of the premature infant is synonymous with preventing childhood accidents at home, especially choking and falls. Strategies for prevention, such as cleaning, organizing the environment, using baby monitors, and fostering intra-family attitudes-such as valuing and uniting family members-were identified. Conversely, precarious living conditions were also observed and recorded in the field diary. Mothers 1, 7, and 8 considered that the behavioral reactions of the preterm infant demonstrate whether or not he or she is feeling safe, whether in an environment or with people different from usual.
Well, We (referring to family 4) just need to be more careful, right? From him (referring to P4) choking, putting something in his mouth, because now he grabs things, pulls everything out […] We have to leave the place cleaner (Aunt P4).
The house has some risks, there are many dogs. (referring to the 6 dogs in the household), there was cleaning material on the underside of the shelf, making it easy for P5 to access and exposing her to a risk. Another risk is the excessive number of steps in the house (Field diary, Family 5, Interviewer 1).
I consider him (referring to P7) Now, he was more insecure, wasn't he, love? (referring to father P7)? Because we (referring to family 7) went through the process, we stayed in the hospital, then we went to my mother's house, then we came to our house, lol, right? So, I think there were many environments for him, you know? And that's why I consider that he has made great progress, because he sleeps in his own room (Mother P7).
Early learning opportunities limited to motor stimulation
The analysis indicates that all families understand that stimulation is related to promoting development, and that stimulation is an act of teaching skills and knowledge that the preterm infant does not yet have. This knowledge was mostly obtained from healthcare professionals. Most of the stimuli mentioned were related to the acquisition of motor skills. Different resources involved in this learning process were mentioned, with toys being the resource mentioned by all families.
Well, stimulation for me is, as they say, like us (referring to family 9) will be teaching him (referring to P9), passing on knowledge to him, right? Well, the one he doesn't have yet, in terms of food, right? Regarding him becoming familiar with his own body, touching things, that sort of thing, that would be my understanding (Father P9).
And we (referring to family 3) watch them make the moves over there (referring to physiotherapy) right? We try too, helping. Repeating the same things doesn't mean overcoming the problem, but rather repeating the things they do to stimulate her (referring to P3) The way they do it...you know? (Maternal grandmother P3).
And we always try to buy a toy to stimulate him (referring to P7) (Mother P7).
It's a time to stimulate as well, right? (referring to the introduction of solid foods) […] The colors of the food we eat are also important. (referring to family 10) choose […] We try to mix things up on the menu to make the dish more colorful, you know? (Mother P10).
The use of screens (cell phones, TVs, etc.) has been interpreted ambiguously by families, being seen as a way to stimulate their development, or as something that should not be encouraged. During the visit to family 6, the use of screens was observed and recorded in a field diary. The analysis also indicated that the stimuli offered to preterm infants are based on the skills expected for their age (corrected or chronological) within the so-called developmental milestones.
In the master bedroom (referring to P6's parents), the room where the P6 playpen-type crib is located has a huge TV, approximately 50 inches, and it was on, showing children's cartoons; in other words, apparently, the parents use this feature for P6 (Field diary, Family 6, Interviewer 1).
So, we (referring to family 3) want to try to stimulate her (referring to P3), to try to encourage her to do things, so she can try to keep up with babies her age, who are 10 months old. (Mother P3) For her normal age, right? (referring to chronological age) That's what our induction is all about.… (Father P3) Stimulating is this… (Mother P3).
Figure 3 aims to present, in a concise manner, the interface between the care provided by the participating families in the research setting and the domains of the NCF.
Interactions between preterm infants and family members within the home context, their relationship to the domains of the NCF and the influence of the preterm infants and family members’ personal characteristics.
DISCUSSION
A search of the current literature did not identify any studies involving preterm infants in the home setting, from the perspective of the NCF. However, two qualitative studies with a similar objective to this one were found, conducted with caregivers of children under 5 years of age17-18. In both studies, the NCF structure was valued by the authors as an appropriate framework for promoting childcare. They also identified that caregivers have a limited understanding of the model, and that there are strengths and weaknesses in the home-based childcare environment17-18. These findings are similar to the results found in this study. Nevertheless, it is worth underscoring the innovative perspective on preterm infants, since they constitute a group at higher risk of developmental impairment, with the home environment being decisive in this outcome19.
The participating families understand that good health is represented by physical well-being or the absence of disease. The preterm infant was considered healthy by caregivers when they observed progress in growth and development, suggesting a focus on physical well-being. This points to a reductionist understanding of health by caregivers, given that WHO defines it as a state of complete physical, mental and social well-being, and not merely the absence of disease20. According to Schramme, the term “complete” does not necessarily refer to perfect well-being, but can alternatively mean a complete well-being, that is, one that includes all its constituent characteristics20.The literature points to a heightened concern among parents of preterm infants regarding the risk of health complications, due to an understanding of their increased fragility3. The increased value placed on and demand for healthcare services for premature infants became evident. It is important to consider that this continuity of care is mediated by the family and its leading role in seeking care, mitigating gaps in follow-up21. The caregivers showed attentiveness to signs or symptoms in the preterm infant that indicated illness. This signals the close relationship between the domains of good health and sensitivity/responsiveness, valued in responsive care4-5. This search for health services was curative or preventive. The NCF emphasizes the close relationship that healthcare professionals have with children and their families in early childhood, providing greater opportunities to provide guidance on comprehensive care to families4-6,16.
In this study, food introduction occurred before 6 months of corrected age for most preterm infants, and no child was exclusively breastfed until 6 months, which goes against NCF’s recommendation4-5. For preterm infants, the age at which food should be introduced depends on their neurological development, and therefore, it is recommended to start at 6 months of corrected age22. However, there is no consensus in the literature on this issue23-24. This lack of consensus was also identified in this study, through the divergences in professional guidelines regarding the introduction of solid foods. This finding was also identified in another study with preterm infants24. A second study found that most children started introducing solid foods after 6 months, and that, as in this research, fruits and vegetables were the main foods offered in the initial phase25. This evidence suggests the relevance of future investigations into this topic. This includes the adoption of corrected age calculation by healthcare professionals for monitoring preterm infants, to support clinical practice regarding the safe and protective introduction of food and nutrition for preterm infants, given that complementary feeding and the transition to a healthy family diet are provided for in the NCF4-5.
Sensitivity and responsiveness to the care needs of preterm infants were widely identified in the caregivers' accounts. Furthermore, affectionate interactions between caregivers and preterm infants were observed by the researchers during home visits. These aspects relate positively to the domain of responsive care, valued by the NCF4-5. Healthcare professionals, therefore, must strengthen this scenario. There is satisfactory evidence for NCF-based educational interventions for child neurodevelopment17,26.
Caregivers value accident prevention as a fundamental aspect of the safety of premature infants. However, this study identified safe family/home environments, as well as precarious/insecure ones. Data analysis indicates that, to prevent domestic accidents, caregivers report constantly supervising preterm infants, a finding supported by the literature17. Nonetheless, despite valuing these aspects, in some households, the researchers observed environmental insecurities such as easy access for the preterm infant to cleaning products and ladders, for example. Therefore, it becomes necessary to broaden caregivers' understanding of accident prevention practices in the home.
The analysis indicates that stimulation often occurs during routine activities at home, such as bath time, mealtimes, playtime, and household chores. This is also a recommendation from the NCF, especially for caregivers with less time available in their daily lives to dedicate to stimulation activities4,5. It became evident that the environment and its various resources were mentioned by the participants as opportunities for early learning, especially toys, which aligns with the NCF. Conversely, screen time, which was also mentioned, constitutes a risky behavior for child development27.
The term development, from the participants' perspective, is primarily related to the acquisition of motor skills. A study indicated that for parents of very premature babies, stimulating motor development was more important than for parents of babies born at term28. This may be related to the fact that preterm infants have an increased risk of developing motor disorders, delays in neuropsychomotor development, and cerebral palsy29. However, according to the NCF, early learning opportunities should encompass the various domains of child development (motor skills, communication, perceptual)4-5. This evidence suggests that it may be beneficial to broaden caregivers' understanding of early learning.
The results suggest that family responses to the different demands of preterm infants are aligned with responsive care, and we infer that this domain has a cross-cutting character for the applicability of the NCF model and for the comprehensiveness of the care provided. In this regard, the absence of responsive care appears to compromise good health, adequate nutrition, early learning, and safety and protection. In light of the above, it is evident that professional guidance is needed for caregivers, to provide a more comprehensive understanding of responsive care, enabling them to identify and respond appropriately to the preterm infant's care needs based on the NCF.
It is worth mentioning the limitations of this study, since the length of time spent at home and the methodology adopted present a snapshot of the reality investigated. Nevertheless, this study provided timely and unprecedented evidence, to the best of our knowledge, as it signals the need to promote understanding and practice among families in the comprehensive care of preterm infants at home. Further research is recommended to expand knowledge about these findings and strengthen comprehensive care in the practice of health professionals and other sectors of society.
CONCLUSION
This study revealed weaknesses in caregivers' understanding of how to identify and respond appropriately and comprehensively to the preterm infants’ care needs. Healthcare was primarily focused on physical health, leading to home-based care that was essentially geared towards promoting the preterm infants’ physical health. Nutritional concerns were related to the early introduction of solid foods and weaknesses related to breastfeeding. Safety and protection measures for caregivers are essentially related to accident prevention, although care practices in this aspect have not always been present in the home. Early learning opportunities were limited to stimulation, primarily of the motor development of preterm infants. Regarding responsive care, it was identified as a cross-cutting domain that encompasses all the others, since it refers to responsiveness and the demands for care for preterm infants. However, this appropriate identification of care demands for adequate responsiveness has proven to be weak.
The health sector plays an important role in promoting comprehensive care for preterm infants at home. Therefore, it is recommended that professionals and nurses act as agents for disseminating this knowledge, through individualized guidance tailored to the needs of each family. Guidelines that cover all areas of the NCF framework.
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NOTES
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ORIGIN OF THE ARTICLE
Extracted from the thesis - Reciprocal interactions and personal characteristics in the home care of the family with the preterm infant: Interfaces with the Nurturing Care Framework, presented to the Graduate Program in Nursing, Universidade Federal de São João del-Rei, in 2025.
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FUNDING INFORMATION
The present work was carried out with the support of the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Funding Code 001, and from the Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), with case number APQ-03978-22.
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APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Ethics Committee in Research of the Universidade Federal de São João Del Rei - Campus Centro Oeste Dona Lindu opinion no. 7.042.021/2024, Certificate of Presentation for Ethical Review 73339023.6.0000.5545.
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TRANSLATED BY
Denise Costa Rodrigues.
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DATA AVAILABILITY
The dataset supporting the results of this study is available upon request from the corresponding author.
The dataset supporting the results of this study is available upon request from the corresponding author.
Source: Data from the research and adaptation of: World Health Organization (WHO)