Purpose To explore neonatal nurses’ perspectives on neuroprotective care in Neonatal Intensive Care Units and identify interventions, facilitators, and barriers to its implementation. Design and methods A qualitative descriptive study used six online focus groups with 27 experienced and specialist neonatal nurses from Neonatal Intensive Care Units across mainland Portugal, recruited through snowball sampling. Data were analyzed inductively and mapped onto the Neonatal Integrative Developmental Care Model, following COREQ. Results Neuroprotective care was perceived as a core, family-centered component of neonatal practice. The most frequently reported intervention domains were Family Partnership and Safe Environment. Facilitators included training, multidisciplinary collaboration, and organizational support, while barriers, particularly workload, limited resources, and insufficient institutional investment, were reported more frequently and hindered consistent implementation. Conclusion Neonatal nurses demonstrate strong conceptual alignment with neuroprotective care principles, but its implementation remains inconsistent and organizationally constrained. Strengthening institutional support, training, and care standardization is crucial to routine practice.
Background Home birth may disrupt continuity between childbirth and formal neonatal care, delaying assessment and referral of sick newborns. Aim To explore neonatal risk recognition, referral activation, and continuity of care after home birth in an Indigenous community in Indonesia. Methods This interpretive ethnography involved 29 participants, including mothers, traditional birth attendants, bomoh, community health workers, health professionals, and community leaders between September 2024 and March 2025. Data from interviews, observations, informal conversations, and document review were analysed using reflexive thematic analysis. Results Antenatal risks were not consistently translated into birth planning or neonatal surveillance; relational continuity with traditional birth attendants sustained community-based care as the first response; and referrals were weakened by household authority, disrupted communication, transport barriers, and limited service readiness. Conclusion Neonatal referral discontinuity reflected system-level fragmentation rather than family delays alone.
Background Admission of a neonate to the neonatal intensive care unit (NICU) is one of the most psychologically challenging experiences during the transition to parenthood. Becoming a mother and a father are distinct parental roles, each influenced by different expectations, relational bonds, and social responsibilities. Aim To compare the stress levels of mothers and fathers of neonates admitted to a NICU using a within-family paired design. Methods A cross-sectional study with sampling enrolled 32 mother-father pairs (n = 64 participants) from a NICU in Türkiye. Paired t-tests and Wilcoxon signed-rank tests were used for within-pair comparisons. Post-hoc power was estimated as a supplementary analysis based on the observed effect sizes and achieved sample size. Results Mothers reported significantly higher stress than fathers on the Sights and Sounds subscale (M = 4.41 ± 0.22 vs. 3.50 ± 0.26; Z = −4.94, p < 0.001; r = 0.87). No significant between-parent differences were observed for Infant's Appearance and Behaviors, Parental Role Alteration, or total PSS:NICU scores (all p > 0.05). Conclusion Mothers and fathers reported similar overall levels of NICU-related stress. A significant between-parent difference was observed only in the Sights and Sounds domain, in which mothers reported higher stress. These findings suggest that parental stress in the NICU should be assessed at the subscale level and that both mothers and fathers should be included in psychosocial assessment and support.
Background Discharge readiness for preterm infants is usually based on weight gain and medical stability, while feeding and swallowing readiness are inconsistently assessed. In resource-constrained settings, discharge planning is further affected by staffing limitations, variable procedures, and limited caregiver preparation. Aim To explore healthcare professionals’ experiences of discharge decision-making for preterm infants, with particular emphasis on how feeding and swallowing readiness and caregiver preparedness are considered within the discharge process. Methods A qualitative study was conducted with 14 healthcare professionals (10 nurses, 4 neonatologists) purposively selected from a public hospital. Data was collected through semi-structured interviews and analysed using thematic analysis. Results Discharge decisions were guided mainly by biomedical criteria and resource pressures. Feeding and swallowing readiness was assessed informally through observation, with limited structured tools. Responsibility for feeding assessment was shared, while final discharge authority remained with the medical team. Caregiver preparation was often opportunistic and time dependent. Conclusion Discharge readiness is shaped by resource-constrained clinical environments in which professional roles are differentiated, while feeding and swallowing readiness and caregiver preparedness are inconsistently integrated into decision-making.
Background The aim of this study was to understand the experiences of registered nurses caring for abandoned infants in the Neonatal Intensive Care unit (NICU). Methods Glaser's Classic Grounded Theory was used to guide the study. A total of 13 semi-structured interviews were conducted: 12 with bedside NICU nurses and one with the researcher. Results The nurses’ perception of parental indifference prompted a conceptual social process of nurses (a) Identifying the need to fill a gap, resulting in (b) redefining the role, leading to (c) experiences of guilt vs responsibility, and ultimately (d) taking over. Conclusion Participants confirmed that NICU-based infant abandonment creates moral harm to nurses suggesting the need for clear visiting expectations and improved monitoring of parental presence. Prompt interventions for infant abandonment will allow nurses to work within their described role.
Objectives To map the available evidence on neurological monitoring in neonatal ECMO and to derive from it an evidence-based nursing-care model that translates monitoring findings into concrete bedside nursing actions across the ECMO trajectory. Methods A JBI scoping review (PRISMA-ScR) searched PubMed, BVS, ScienceDirect, Scopus, Web of Science and grey literature (February–April 2025). Included: studies in English, Spanish or Portuguese (1991–2025) on neuromonitoring in term or late-preterm neonates (≤28 days) on ECMO; two reviewers screened and extracted data independently. Results Twenty studies were included: 8 reviews, 7 observational, 2 pilot, 2 case series, 1 guideline. Reported modalities: cranial ultrasound (40 %), aEEG (40 %), EEG (35 %), NIRS (35 %), brain MRI (25 %), head CT (20 %), transcranial Doppler/biomarkers (10 %). Intracranial haemorrhage, ischaemic injury and seizures dominated; recurrent risk factors were prematurity, carotid cannulation, coagulopathy, venoarterial configuration and low birthweight. Only two studies described nursing care. The proposed model is organised by the three ECMO phases (pre-cannulation, during ECMO and post-decannulation), each specifying the clinical objective, core monitoring actions, nursing-led tasks and escalation steps. Conclusions The findings suggest increasing adoption of multimodal bedside neuromonitoring in neonatal ECMO; nursing-specific evidence remains underreported, and several elements of the proposed model rest on extrapolation rather than direct nursing evidence.
A significant number of parents experience disrupted sleep following their infant's discharge from the neonatal unit. However, the extent of sleep disruption among both mothers and fathers of preterm infants after hospital discharge remains poorly documented. Few studies have assessed parental sleep quality using objective measures such as actigraphy. Similarly, limited research has examined the sleep quality of infants after discharge from the neonatal unit. This study aimed to describe the sleep patterns of preterm infants and their parents one month after discharge from the NICU. It also sought to compare mothers' and fathers' sleep. Thirty families participated in this descriptive study. One month post-discharge, parents and infants wore an actigraph for three consecutive days and nights to monitor sleep. Each parent completed a sleep diary and self-report questionnaires about their own sleep, while one parent recorded the infant's sleep. Results indicated that although both parents experienced sleep disturbances, mothers spent more time awake during the night and had lower sleep efficiency compared to fathers. Infants' sleep duration was consistent with current guidelines. Healthcare professionals should consider the sleep characteristics of both parents following hospital discharge to better support families and improve access to community resources.
Purpose This study examined early parenthood development and depressive symptoms in parents of infants discharged from the neonatal intensive care unit (NICU). Specifically, we explored the association between depressive symptoms and aspects of parenthood development and identified factors associated with an increased risk of parental depression. The ultimate aim was to inform targeted interventions for families after NICU discharge. Methods Parents of infants at three months corrected age after NICU admission completed questionnaires assessing depressive symptoms, parent-child bonding, parental confidence, perceptions of infant behaviour, parenting satisfaction, and family strain. Multivariable logistic regression analyses were conducted to identify factors associated with depressive symptoms. Results The study included 530 parents of 271 infants admitted to the NICU of a single medical centre. Parents reported fewer bonding problems than normative samples of parents with infants. Forty-four percent reported satisfaction with feeding, sleeping, and comforting their infants. However, depressive symptoms were more prevalent than in normative populations, with 41% of parents scoring above the risk threshold. Factors independently associated with depressive symptoms at three months corrected age included being the mother rather than the father, being born outside the Netherlands, having an infant with grade II or higher intraventricular hemorrhage, and being identified as potentially requiring psychosocial support during the NICU admission. Conclusions While many parents reported positive relationships with their infants, a substantial proportion experienced depressive symptoms. These findings underscore the need for targeted psychosocial support during NICU admission and throughout the post-discharge period.
Vascular access (VA) procedures are an almost universal experience for preterm infants and their parents. Recent innovations in VA device design and practice, including insertion techniques, securement strategies, and maintenance protocols, have sought to reduce short-term complications. However, VA may also be associated with a largely underexplored burden of longer-term consequences.This article presents a preliminary interpretation of contributions provided by 36 unrelated participants (13 adults born preterm, 23 parents) during an on-line group reflective activity supported by independent reflective accounts provided by the authors. Using an inductive thematic approach, six key themes were identified that capture both the visible and unseen consequences associated with early-life invasive procedures. Whilst exploratory, these findings highlight the potential long-term physical and emotional implications of neonatal VA and may help inform future discussion regarding compassionate, developmentally supportive, family-integrated care practices, as well as topics for future research.
Background Working as a neonatal nurse requires advanced clinical skills and the ability to support stressed and anxious parents. However, little is known about how newly employed nurses are onboarded into this complex care environment. This study aimed to map onboarding practices for newly hired nurses in Swedish neonatal units. Methods A national cross-sectional survey was sent to all nurse managers in Swedish neonatal units (n = 37). Eighteen managers participated (response rate 53%). Quantitative data were analyzed descriptively, and free-text responses were analyzed using inductive content analysis. Results All responding units reported hiring newly graduated nurses. The typical onboarding period was 10–12 weeks. Structured mentorship programs were reported by 11 units, while competency assessment tools were used in a minority of units. Free-text responses described a competent neonatal nurse as someone who works proactively, understands the rationale behind interventions, and anticipates deterioration. Conclusion Onboarding practices vary substantially across units. Common elements include extended introductions and structured mentorship, whereas formal specialist education is less emphasized.
Background Neonatal procedural pain is frequent in intensive care settings, and effective non-pharmacological interventions are needed. Evidence comparing different auditory stimuli is limited. Objective To compare the effects of three auditory stimuli on neonatal pain during heel lance. Methods This assessor-blinded randomized controlled trial included eligible neonates born between 28 and 42 weeks of gestation who were randomly assigned to one of four groups: maternal prenatal music, white noise, heartbeat sound, or control. Results A total of 84 neonates were enrolled in the study. The enrolled neonates had a mean gestational age of 33.92 ± 3.41 weeks; 53.6% were male and 46.4% were female. During heel lance, the mean NIAPAS pain score was significantly lower in the white noise group than in the control group (8.81 ± 3.57 vs. 12.45 ± 2.45; p = 0.007). One minute after the procedure, mean pain scores were 2.48 ± 1.85 in the music group, 4.19 ± 2.53 in the heartbeat group, 3.07 ± 2.18 in the white noise group, and 7.26 ± 3.03 in the control group, with significantly lower scores in all intervention groups than in the control group (music: p < 0.001; heartbeat: p = 0.030; white noise: p = 0.011). Mean crying duration was 18.95 ± 9.11 s in the music group, 18.43 ± 11.43 s in the heartbeat group, 20.86 ± 11.49 s in the white noise group, and 27.14 ± 12.04 s in the control group. Crying duration was significantly shorter in the music (p = 0.010) and heartbeat (p = 0.025) groups than in the control group. Conclusion White noise reduced procedural pain, whereas maternal prenatal music and heartbeat sounds were effective in reducing post-procedural pain and crying. These findings suggest that simple auditory interventions may be incorporated into routine neonatal care as safe, inexpensive, and easily applicable non-pharmacological strategies for procedural pain management. Further studies are warranted to confirm these findings across different neonatal populations and clinical settings.
Background Compassion fatigue may be associated with neonatal intensive care unit (NICU) nurses’ ability to provide quality palliative care. Understanding this relationship may contribute to the development of supportive strategies for neonatal nurses and neonatal palliative care practice. Aim This study examined the relationship between NICU nurses’ attitudes toward palliative care and their levels of compassion fatigue. Methods A descriptive cross-sectional design was used. A total of 164 neonatal nurses participated, and data were collected through an online questionnaire. Results Participants had a mean age of 32.2 ± 5.8 years; 76.2% were women. Regression analysis revealed that compassion fatigue accounted for 19% of the variance in palliative care attitudes. Higher compassion fatigue scores were significantly associated with lower attitudes toward neonatal palliative care. Correlation analysis confirmed a significant negative relationship between the total mean scores of the two scales. Conclusion Supporting NICU nurses with interventions to reduce compassion fatigue may help strengthen positive attitudes toward neonatal palliative care. However, causal relationships cannot be inferred because of the cross-sectional design.
