Effects of family-integrated care on weight gain, breastfeeding, hospital stay, and infection in NICU preterm infants: a meta-analysis

Objective To systematically evaluate the effects of family-integrated care (FICare) on hospital stay, weight gain rate, breastfeeding rate, and nosocomial infection rate in premature infants in the NICU, given that existing individual studies have yielded inconsistent conclusions and no comprehensive meta-analysis has yet synthesized this evidence. Methods Randomized controlled trials and eligible non-randomized comparative studies on FICare for premature infants were searched from PubMed, Medline, Web of Science, Cochrane Library, and EMBASE. Two researchers independently screened literature, extracted data, and assessed risk of bias using the Cochrane Risk of Bias-2 tool for randomized controlled trials and the Newcastle-Ottawa Scale for non-randomized studies. Meta-analysis used mean difference (MD) or standardized MD for continuous outcomes and odds ratio (OR) for dichotomous outcomes, with 95% confidence intervals (CI). Heterogeneity was assessed using I 2 ; sensitivity analysis examined whether effect directions were driven by single studies. Publication bias was not formally assessed due to the limited number of studies per outcome. Results Six studies involving a total of 4,138 premature infants were included, with 2,010 infants in the FICare group and 2,128 infants in the conventional care group. Compared with conventional care, FICare significantly increased weight gain rate (pooled MD = 4.35, 95% CI [2.00, 6.69], P < 0.05; I 2 = 98.55%; unit: g/day), and improved breastfeeding rate (pooled OR = 3.06, 95% CI [1.58, 5.99], P = 0.01; I 2 = 91.82%). No significant differences were found in length of hospital stay (pooled MD = −3.63, 95% CI [−7.80, 0.54], P = 0.09; I 2 = 99.79%; unit: days) or nosocomial infection rate (pooled OR = 0.90, 95% CI [0.68, 1.17], P = 0.41; I 2 = 27.33%). Subgroup analysis showed that in Chinese studies, FICare significantly shortened hospital stay (pooled MD = −6.93, 95% CI [−7.22, −6.65], P < 0.05), but not in international multicenter studies. Weight gain rate improved in both severe and stable condition subgroups. Sensitivity analysis showed consistent direction of effects across all outcomes. Conclusion Low-certainty evidence suggests that FICare may be associated with improved weight gain and exclusive breastfeeding rates in NICU premature infants, but shows no significant effect on hospital stay duration or nosocomial infection rate. The findings are promising but should be interpreted with caution due to high heterogeneity and the limited number of included studies.