The ability to develop attachment begins in humans from gestation [1] it contributes to survival and allows them to obtain satisfaction [2]. Preterm birth generates an unplanned physical separation between the father-baby dyad that limits their interaction time [3][4]. Every year about 30 million premature babies are born affecting families around the world. At least 2.5 million of these babies die from complications, this implies that newborns at risk need specialized attention [5]. The kangaroo care method saves the lives of thousands of premature babies every year, by promoting the establishment of attachment [6] it has been proven that even twenty years after its application, it has positive results in the social growth and development of abilities [7] [8] [9].
The Hospitalization of the baby after birth is unexpected and in most cases negative [10], the experience with this type of birth can generate discomfort, anxiety, and depression, [11] and can even cause typical symptoms of post-traumatic stress disorder, up to one year after [12] [13], low social support, the stress caused by childbirth[14] and challenges related with the fathers' health and financial problems are frequent predictors for this condition [15] [16]. The father usually struggles between the joy of having his newborn baby and the sadness that he is in the NICU [17]. The fact that hospitals do not allow fathers to accompany mothers on the nights with their babies difficult the care of the newborn, so accessing psychotherapeutic care would increase the chances of establishing a good relationship, and generate adequate coping strategies [18]. The separation between father and baby, the exclusion of the role of fathers as primary caregivers [19] and postpartum depression, affect the establishment of bond and attachment between father and baby, early identification will help improve the relationship between these two [20].
Most studies on parents in NICU focus on the mother [21], the information on the father-baby dyad is less compared to that of mother-baby [22] [23], although fathers have neurological and hormonal changes that support their need for attachment with the baby, society has imparted different expectations compare to the mother [24]. Fathers have different needs, usually, their difficulties are hidden and silenced [25], understanding the father's experience would improve care in the neonatal units and enhance family-focused health services [9, 26, 27]; therefore, programs that focus on gender equality are needed, identifying their differences [28], will help maintain the commitment father-baby [29].
Fathers generally experience difficulties in developing their parental roles due to the low autonomy they have in NICU and the restrictions they have with the visiting hours [30, 31, 32]. Among the things that the health personnel should take into account when taking care of the premature baby, they must communicate with empathy from the beginning [33, 34], constantly encourage fathers to participate in care, provide information to understand the diagnosis of their children [35], carry out new strategies such as including parents in medical rounds to improve their participation [36], rely on technologies that allow fathers to feel closer to their babies and share their experiences with other parents in the same situation [37].
Consequently, it is necessary to understand the relationship between the father and the premature baby in the NICU. Also, the need for studies focused on this topic increases due to the low production of studies focused only on the father. A better understanding of this issue will contribute to the physical and mental health of the father and baby and will help to design hospital protocols that allow the active role of the father.
OBJECTIVES
This review aims to understand the father's experience in the NICU while accompanying his premature baby, including the feelings and emotions that the father experiences, as well as to highlight the influence of the father on the newborn. We hope to gain insight into how the attachment relationship between the father and premature infant is developed, and how the kangaroo care method helps to establish it and to have the perception of the father at the NICU.