The NeoIPC framework has matured significantly by the end of the third period, encompassing robust project management, communication and dissemination activities.
Insights gathered during the first period led to identify kangaroo care (skin to skin contact between babies and their mothers/other carers for a prolonged period, often several hours) as the intervention most likely to be of interest. Any intervention tested in as large a trial should be deemed highly relevant and feasible by clinical staff. Kangaroo care is already supported by indirect evidence for an important effect on neonatal infection. Analysis of information gathered during the first period was completed and incorporated into the protocol of the main study (NeoDeco). This includes feedback from neonatal units about their current state of IPC, antibiotic use and resistant bacterial carriage. In brief, we could confirm that better kangaroo care is the critical intervention for neonatal units to consider. Furthermore, strong consistency of the level of carriage of resistant bacteria in participating units has enabled us to refine how we will look at the effect of kangaroo care on this.
The NeoDeco trial investigates whether better kangaroo care practiced at the unit-level (offered to all babies for whom this is relevant in a given neonatal unit) reduces the rate at which babies are affected by infection needing antibiotic treatment. The trial will also test what can be done to help units improve offering kangaroo care by developing and evaluating implementation strategies. In total, 24 neonatal units taking part in this trial are sufficient to measure an effect important to babies, their families and healthcare providers. Importantly, these neonatal units are allocated by chance (randomised) to either continuing current levels of IPC and kangaroo care or to engaging with implementation strategies to improve kangaroo care. This will allow us to compare the added benefit (if any) of kangaroo care on infections.
All activities required to find and set up neonatal units taking part in the trial have been completed. The NeoDeco trial is now fully underway, involving units from Greece, Italy, Spain, Switzerland and the United Kingdom with a very diverse profile in terms of size and structure as well as with different approaches to neonatal IPC and kangaroo care. The units interact with the implementation, surveillance and microbiology teams in the project to make sure that the trial protocol and procedures are clear and that all units have access to appropriate support in implementing the study.
Communication and outreach have intensified, with expanded social media engagement, new video materials for healthcare staff and parents, and collaboration with a wide range of groups, societies and professional bodies that are likely to find our work relevant.
The Clinical Practice Network has continued to expand, and now includes 173 units across 39 countries. CPN steering board members representing multiple disciplines from 7 countries have further developed the planned activities and engagement strategy, including hosting of workshops and webinars, provision of open access materials on neonatal IPC through the website and establishing a pathway to disseminate NeoIPC outputs.
