Practices and challenges of family involvement in neonatal intensive care units (NICUs) across Asia: a multinational survey of the Asian neonatal network

Objective This study aimed to explore the role of family involvement in neonatal intensive care units (NICUs) across Southeast and East Asia, focusing on the implementation of family-integrated care, kangaroo mother care, and developmental care practices. The study sought to identify variations in care practices between high-income and low- and middle-income countries and to provide actionable insights for improving neonatal outcomes. Design A multinational survey was conducted across 336 NICUs in eight Asian neonatal networks (Japan, Indonesia, Malaysia, the Philippines, Singapore, South Korea, Taiwan, and Thailand) as part of the AsianNeo Network in 2021. The survey, adapted from the International Network for Evaluation of Outcomes (iNeo) tool, assessed family-centred care practices, kangaroo mother care, and developmental care. Results Significant differences were observed between high-income and low- and middle-income countries. High-income countries had better facilities for parental involvement, such as family rooms and extended visitation policies, but were more restrictive in kangaroo mother care duration. Low- and middle-income countries prioritized maternal involvement, with longer kangaroo mother care durations and greater emphasis on breastfeeding support. Developmental care practices, such as cyclical light exposure and noise reduction, were more prevalent in high-income countries. Conclusions The study highlights the need for context-specific strategies to enhance family-centred care in NICUs. Low- and middle-income countries should invest in infrastructure and training to support family-integrated care and developmental practices, while high-income countries can adopt more flexible kangaroo mother care policies. Collaborative efforts within networks like AsianNeo can facilitate knowledge exchange and improve neonatal care outcomes across diverse resource settings.