Maternal Concerns in Home Care for the Premature Newborn: An Integrative Review

To identify and analyze the scientific literature, both national and international, concerning the primary maternal concerns about caring for premature newborns at home.

Methods:

This integrative review is based on the guiding question: “What scientific publications from 2012 to 2021 address maternal concerns about the care of premature newborns at home?”. Searches were conducted in the electronic databases: Embase, Medline, Web of Science, Lilacs, Scielo, and Cochrane Library.

Results:

A total of 21 articles were identified. The qualitative analysis showed that maternal concerns pertained to breastfeeding, hygiene, sunbathing practices, managing infant colic, identifying signs, symptoms, and clinical changes, temperature control, and the third phase of the kangaroo method.

Conclusions:

Maternal uncertainties underscore the importance of enhancing strategies focused on supporting families and ensuring continued care for neonates at home.

Descriptors:
Infant Care; Infant Premature; Patient Discharge; Home Nursing; Nursing Care

Database	Search Strategy/Syntax	Sample (n)
EMBASE	(‘home care’ OR (care AND domiciliary)) AND (premature OR (newborn AND premature))	01
Web of Science	Premature newborn (All fields) and postnatal care (All fields) or patient discharge (All fields) and home care (All fields) and maternal behavior (All fields) and professional-family relations (All fields)	11
LILACS	(“newborn premature” OR “newborn”) AND (“postnatal” OR “maternal behavior”) AND ( db:(“LILACS”))	1369
PUBMED	(Infant OR premature [All Fields]) AND “home care” AND “maternal care pattern” [All Fields]	102
SCIELO	(“newborn premature” OR “newborn”) AND (“postnatal” OR “maternal behavior”) Filters applied: Not used.	124
Cochrane Library	Cochrane Reviews matching “premature newborn” in Title Abstract Keyword AND “ maternal care” in Title Abstract Keyword AND “patient discharge” in Title Abstract Keyword AND “home care” in Title Abstract Keyword AND “professional-family relationships” in Title Abstract Keyword - (Word variations have been searched)	0
Total		1612

Title/Reference	Year/ Country	Design	Outcome	Level of Evidence
Recém-nascido prematuro: suporte materno domiciliar para o cuidado (¹⁹19 Couto FF, Praça NS. Recém-nascido prematuro: suporte materno domiciliar para o cuidado. Rev Bras Enferm. 2012;65(1):19-26. https://doi.org/10.1590/S0034-71672012000100003 https://doi.org/10.1590/S0034-7167201200... )	2012 Brazil	Descriptive Study	At home, mothers of premature newborns had questions about handling colic, the number of bowel movements, and sun exposure. To address their uncertainties and overcome feelings of fear and insecurity in performing certain tasks, they sought health professionals and consulted the guidebook provided at the time of hospital discharge.	VI
Gaining confidence and perspective: a phenomenological study of mothers’ lived experiences caring for infants at home after neonatal unit discharge(²⁰20 Murdoch MR, Franck LS. Gaining confidence and perspective: a phenomenological study of mothers’ lived experiences caring for infants at home after neonatal unit discharge. J Adv Nurs. 2012;68(9):2008-20. https://doi.org/10.1111/j.1365-2648.2011.05891.x https://doi.org/10.1111/j.1365-2648.2011... )	2012 Canada	Phenomenological Study	In the home setting, mothers were anxious about the fragile health of their premature infants and were concerned about their well-being. Using instinct and a trial-and-error approach, they tried to identify their baby’s needs and signs of pain or discomfort.	VI
Experiência materna no cuidado domiciliar ao recém-nascido prematuro (²¹21 Schmidt KT, Terassi M, Marcon SS, Higarashi IH. Práticas da equipe de enfermagem no processo de alta do bebê pré-termo. Rev Bras Enferm. 2013;66(6):833-9. https://doi.org/10.1590/S0034-71672013000600004 https://doi.org/10.1590/S0034-7167201300... )	2012 Brazil	Qualitative Study	For home care, mothers of premature infants expressed the need for guidance on child development, breathing, vaccination, breastfeeding, and the preparation and administration of medications.	VI
Alta hospitalar e o cuidado do recém-nascido prematuro no domicílio: vivência materna (²²22 Frota MA, Silva PFR, Moraes SR, Martins EMCS, Chaves EMC, Silva CAB. Alta hospitalar e o cuidado do recém-nascido prematuro no domicílio: vivência materna. Esc Anna Nery. 2013;17(2):277-83. https://doi.org/10.1590/S1414-81452013000200011 https://doi.org/10.1590/S1414-8145201300... )	2013 Brazil	Qualitative Study	The mothers’ experiences during the first week of home care following the hospital discharge of their premature newborns were marked by questions about bathing, signs of sickness, and other information not provided by professionals upon discharge.	VI
Prematuro: Experiência materna durante amamentação em unidade de terapia intensiva neonatal e pós-alta (²³23 Melo LM, Machado MMT, Leite ÁJM, Rolim MKC. Prematuro: experiência materna durante amamentação em unidade de terapia intensiva neonatal e pós-alta. Rev Rene [Internet]. 2013 [cited 2022 Aug 28];14(3):512-20. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/lil-698950 https://pesquisa.bvsalud.org/portal/reso... )	2013 Brazil	Qualitative Study	At home, mothers had questions about continuing breastfeeding and the subsequent feeding regimen for the premature newborn.	VI
Caring for premature child at home: from fear and doubt to trust(²⁴24 González MPO, Espitia EC. Caring for a premature child at home: from fear and doubt to trust. Texto Contexto Enferm. 2014;23(4):828-35. https://doi.org/10.1590/0104-07072014003280013 https://doi.org/10.1590/0104-07072014003... )	2014 Colombia	Phenomenological Study	The first night that mothers spent at home caring for their child was long, filled with anguish and uncertainties. By the next morning, they felt exhausted, filled with questions and concerns, fearing that their child might have lost weight or developed a complication that would require re-admission.	VI
Ações de enfermagem na assistência domiciliar ao recém-nascido de muito baixo peso (²⁵25 Sassá AH, Gaíva MAM, Higarashi IH, Marcon SS. Nursing actions in homecare to extremely low birth weight infant. Acta Paul Enferm. 2014;27(5):492-8. https://doi.org/10.1590/1982-0194201400080 https://doi.org/10.1590/1982-01942014000... )	2014 Brazil	Qualitative Study	Mothers’ concerns during the daily care of the premature baby at home centered around hygiene, comfort, and recognizing signs and symptoms that appeared after the hospital discharge.	VI
Life after discharge: what parents of preterm infants say about their transition to home(²⁶26 Boykova M. Life after discharge: what parents of preterm infants say about their transition to home. Newborn Infant Nurs Rev. 2016;16(2):58-65. https://doi.org/10.1053/j.nainr.2016.03.002 https://doi.org/10.1053/j.nainr.2016.03.... )	2016 USA	Qualitative Study	Uncertainties about breastfeeding, caring for the premature newborn at home without professional supervision, and finding reliable information sources led to stress, worry, and anxiety.	VI
Preparing for post-discharge care of premature infants: Experiences of parents (²⁷27 Osorio Galeano SP, Ochoa Marín SC, Semenic S. Preparing for post-discharge care of premature infants: experiences of parents. Invest Educ Enferm [Internet]. 2017 [cited 2022 Aug 28];35(1):100-8. https://doi.org/10.17533/udea.iee.v35n1a12 https://doi.org/10.17533/udea.iee.v35n1a... )	2017 Colombia	Qualitative Study	The findings emphasize the importance of creating institutional follow-up programs to ease the transition of the premature baby to the home setting. The value of family follow-up and the ability to contact the healthcare unit by phone for queries were highlighted as beneficial aspects of home care.	VI
Theory of infants’ transition management from then neonatal intensive care unit to home: a qualitative study(²⁸28 Namnabati M, Zamanzadeh V, Valizadeh L, Tazakori Z, Nyqvist KH. Theory of infants’ transition management from the neonatal intensive care unit to home: a qualitative study. Int J Pediatr. 2017;5(1):4151-62. https://doi.org/10.22038/ijp.2016.7887 https://doi.org/10.22038/ijp.2016.7887... )	2017 Iran	Qualitative Study - Grounded Theory	Typically, mothers of premature infants are not prepared to care for their children immediately postpartum. Once home, the mothers’ primary concern was the survival of their premature child, who had previously been under professional supervision in the hospital.	VI
Percepção das mães quanto à competência materna nos cuidados domiciliares do recém-nascido prematuro (²⁹29 Machineski GG, Reis NN, Vieira CS, Oliveira Toso BRG, Caldeira S. Percepção das mães quanto à competência materna nos cuidados domiciliares do recém-nascido prematuro. Saúde (Santa Maria). 2018;3(44). https://doi.org/10.5902/2236583431627 https://doi.org/10.5902/2236583431627... )	2018 Brazil	Phenomenological Study	It was found that mothers of premature newborns have insufficient knowledge for home care of their child, especially when without the assistance of a healthcare professional, leading to feelings of fear and insecurity even in the face of common newborn complications.	VI
Aleitamento materno exclusivo de prematuros e motivos para sua interrupção no primeiro mês pós-alta hospitalar (³⁰30 Lima APE, Castral TC, Leal LP. Aleitamento materno exclusivo de prematuros e motivos para sua interrupção no primeiro mês pós-alta hospitalar. Rev Gaucha Enferm. 2019;40:e20180406. https://doi.org/10.1590/1983-1447.2019.20180406 https://doi.org/10.1590/1983-1447.2019.2... )	2019 Brazil	Cross-sectional Study	It was observed that the lack of guidance for the mother might be related to the weaning of the premature newborn after hospital discharge.	VI
Dúvidas maternas na alta hospitalar do recém-nascido (³¹31 Rocha GMN, Feitosa MR, Carvalho REFL, Dodt RCM, Queiroz MVO, Chaves EMC. Dúvidas maternas na alta hospitalar do recém-nascido. Rev Univap. 2019;25(49):93-103. https://doi.org/10.18066/revistaunivap.v25i49.1968 https://doi.org/10.18066/revistaunivap.v... )	2019 Brazil	Quantitative Descriptive Study	The majority of mothers stated they were not prepared to care for their child (60.1%). The most frequently mentioned uncertainties were about bathing (60%) and breastfeeding (56.7%).	VI
Vivência materna com o Método Canguru no domicílio (³²32 Reichert APS, Soares AR, Bezerra ICS, Dias TKC, Guedes ATA, Vieira DS. Vivência materna com o método canguru no domicílio. Reme Rev Mineira Enferm. 2020;24:1-8. https://doi.org/10.5935/1415-2762.20200024 https://doi.org/10.5935/1415-2762.202000... )	2020 Brazil	Qualitative Study	Mothers experienced feelings of fear and insecurity during the home phase of the Kangaroo Method and mentioned a lack of guidance provided by health professionals. They face daily challenges, such as temperature control of the premature newborn, breastfeeding, identifying colic, and the importance of the Kangaroo position at home.	VI
Oportunidades de cuidados à criança prematura: visita domiciliar e suporte telefônico (³³33 Silva RMM, Zilly A, Nonose ERDS, Fonseca LMM, Mello DF. Care opportunities for premature infants: home visits and telephone support. Rev Latino-Am Enfermagem. 2020;28:1-8. https://doi.org/10.1590/1518-8345.3520.3308 https://doi.org/10.1590/1518-8345.3520.3... )	2020 Brazil	Qualitative Study	Mothers’ questions regarding care included feeding, bathing, diaper changing, stool characteristics, clinical changes, referrals to specialists, and the need for tests.	VI
Vulnerabilidades para a criança prematura:contextos domiciliar e institucional (³⁴34 Silva RMM, Zilly A, Toninato APC, Pancieri L, Furtado MCC, Mello DF. The vulnerabilities of premature children: home and institutional contexts. Rev Bras Enferm. 2020;73(suppl 4):e20190218. https://doi.org/10.1590/0034-7167-2019-0218 https://doi.org/10.1590/0034-7167-2019-0... )	2020 Brazil	Qualitative Study	Home experiences with the premature baby led to concerns related to breastfeeding, signs of clinical changes, and fears of possible re-hospitalization.	VI
Mothers’ experiences of caring for preterm babies at home: qualitative insights from an urban setting in a middle-income country(³⁵35 Garti I, Donkor E, Musah N. Mothers’ experiences of caring for preterm babies at home: qualitative insights from an urban setting in a middle-income country. BMC Pregnancy Childbirth. 2021;21(1):395. https://doi.org/10.1080/03056244.2018.1546429 https://doi.org/10.1080/03056244.2018.15... )	2021 Ghana	Qualitative Study	Mothers expressed uncertainties about feeding the premature baby, temperature control, infection prevention, and reported difficulties in balancing child care with household chores.	VI
Conhecimento de mães sobre cuidados aos recém-nascidos prematuros e aplicação do Método Canguru no domicílio (³⁶36 Gomes MP, Saráty SB, Pereira AA. Mothers’ knowledge of premature newborn care and application of Kangaroo Mother Care at home. Rev Bras Enferm. 2021;74(6):e20200717. https://doi.org/10.1590/0034-7167-2020-0717 https://doi.org/10.1590/0034-7167-2020-0... )	2021 Brazil	Qualitative Study	There were observed strengths and weaknesses in the care of the premature newborn and in the implementation of the Kangaroo Method at home. The main questions from mothers were about warning signs for complications.	VI
A Study of Maternal Competence in Preterm Birth Condition, during the Transition from Hospital to Home: An Early Intervention Program’s Proposal(³⁷37 Polizzi C, Perricone G, Morales MR, Burgio S. A Study of maternal competence in preterm birth condition, during the transition from hospital to home: an early Intervention Program’s Proposal. Int J Environ Res Public Health. 2021;18(16):8670. https://doi.org/10.3390/ijerph18168670 https://doi.org/10.3390/ijerph18168670... )	2021 Italy	Quantitative Study	There was a trend towards undermining maternal competence in terms of the ability to care for the premature newborn in the post-discharge period. When mothers realize they don’t understand the true meaning of their child’s signals, an essential condition to feel confident in seeking solutions and making decisions, they can become extremely distressed.	IV
Demandas de aprendizagem de famílias sobre cuidados pós-natais aos recém-nascidos (³⁸38 Santos AST, Góes FGB, Ledo BC, Silva LF, Bastos MPC, Silva MA. Family learning demands about post-natal newborn care. Texto Contexto Enferm. 2021;30:1-15. https://doi.org/10.1590/1980-265X-TCE-2019-0352 https://doi.org/10.1590/1980-265X-TCE-20... )	2021 Brazil	Qualitative Study	There were evident misunderstandings and incorrect practices related to intimate hygiene, diaper changing, bathing, cleaning of the umbilical stump, use of products on the premature baby’s skin, and breastfeeding.	VI
Cuidados com o recém-nascido prematuro após a alta hospitalar: investigação das demandas familiares (³⁹39 Silva CG, Fujinaga CI, Brek EF, Valenga F. Cuidados com o recém-nascido prematuro após a alta hospitalar: investigação das demandas familiares. Saúde Pesqui. 2021;14(2):289-97. https://doi.org/10.17765/2176-9206.2021v14n2e9035 https://doi.org/10.17765/2176-9206.2021v... )	2021 Brazil	Qualitative Study	Questions from mothers and relatives were highlighted concerning feeding, hygiene, sleep, and the presence of clinical changes.	VI

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[1] Corresponding author: Thaís Emanuele da Conceição, E-mail: thaisemanuelec@hotmail.com