BACKGROUND:Delayed attainment of full enteral feeding (FEF) remains a challenge in preterm infants and is associated with gastrointestinal maturation and readiness for hospital discharge. Although kangaroo care (KC) is widely implemented in neonatal intensive care units (NICUs), its effect on time to FEF is unclear. PURPOSE:To synthesize evidence from randomized controlled trials (RCTs) examining the effect of KC on time to FEF in preterm infants. METHODS:A systematic review and meta-analysis were conducted in accordance with Joanna Briggs Institute methodology and PRISMA 2020 guidelines. RCTs comparing KC with standard NICU care and reporting time to FEF were identified by searching 5 databases from inception to October 17, 2025. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. RESULTS:Five RCTs involving 624 preterm infants were included. Meta-analysis showed that KC significantly shortened time to FEF compared with standard care (mean difference = -3.32 days, 95% CI [-5.88, -0.76], P = .01; I2 = 91%). Infants receiving KC also demonstrated greater weight gain than controls (mean difference = 5.68 g, P = .0002). No significant difference was observed between groups in length of hospital stay (P = .62). IMPLICATIONS FOR PRACTICE AND RESEARCH:KC may serve as an effective, nursing-led intervention to support feeding progression and early growth in preterm infants while reinforcing family-centered care in the NICU. Given variability in protocols and outcome definitions, further multicenter RCTs are needed to confirm these findings and clarify implications for hospital resource utilization.
BACKGROUND:Neonate patients receiving care may benefit from postural alignment support in improving neurodevelopment, physiologic functioning, and stability. PURPOSE:To assess the effectiveness of an infant positioning tool on patient positioning in a neonatal intensive care unit (NICU). METHODS:A pre-post study design was used at a NICU within a free-standing children's hospital located in the Midwestern United States. The study was based on the implementation of an infant positioning tool by nursing. Study personnel collected neonate positioning scores before and after the tool's implementation. The instrument includes score values from 0 to 12, with higher scores representing better positioning. An intent-to-treat design was used to evaluate change. The primary study outcome was the observed median improvement in positioning scores. RESULTS:Study sample included 168 (51%) observations collected from 89 unique neonates during the preintervention period and 159 (49%) observations collected from 69 unique neonates during the postintervention period. The sample had a median gestational age of 36 weeks, and most patients were direct NICU admissions. Primary admitting diagnoses were related to respiratory distress or failure. Median neonate positioning scores were 8 (interquartile range: 6, 9) in the preintervention and 10 (interquartile range: 9, 11) in the postintervention period represented by an estimated 2.1 (95% CI: 1.6, 2.8) median point increase. IMPLICATIONS FOR PRACTICE:Study revealed an observed improvement in NICU infant positioning scores after the implemented change. Literature indicates that long-term impacts could include multisystemic improvements including orthopedic alignment, neurologic development, sensory/vestibular development, respiratory status, and potential decreased length of stay.
BACKGROUND:The ability of Neonatal Intensive Care Unit (NICU) nurses to recognize clinical cues indicating neonatal deterioration and make timely clinical decisions is essential for positive patient outcomes. How nurses progress from novice to expert in clinical cue recognition and decision making remains underexplored. PURPOSE:This qualitative descriptive study examines how cue recognition, clinical decision making, assessment techniques, and advocacy confidence evolve across novice, intermediate, and experienced NICU nurses. METHODS:Individual semi-structured interviews were conducted with NICU nurses. Thematic analysis was used to identify patterns of cue detection and clinical decision making within and across experience levels. RESULTS:Findings revealed a gradual shift from monitor dependence to behavioral assessment, protocol-based to individualized care, and reactive responses to predictive interventions. Novices relied on monitors, whereas experts prioritized subtle behavioral and physiological cues. IMPLICATIONS FOR PRACTICE AND RESEARCH:These findings emphasize the need for mentorship programs fostering pattern recognition, early advocacy, and diagnostic differentiation to accelerate NICU clinical expertise. Developing an assessment tool and signal detection trials to evaluate nurses' cue recognition and clinical decision-making skills could support structured staff development.
BACKGROUND:Premature infants frequently experience feeding difficulties because of immature oral-motor coordination. The Premature Infant Oral Motor Intervention (PIOMI) has been shown to improve feeding skills, but objective evidence regarding its effects on orofacial muscle activity remains limited. PURPOSE:To evaluate the effects of PIOMI on orofacial muscle activity and feeding outcomes in premature infants with feeding disorders. METHODS:This pilot study was conducted in Neonatal Intensive Care Units in Mazandaran, Iran. Ten premature infants (gestational age 29-36 weeks; mean 32.4 ± 2.1; birth weight 1706 ± 476 g) received daily PIOMI sessions for 7 days by a trained speech therapist. Orofacial muscle activity (masseter, zygomatic, and orbicularis oris) was measured using surface electromyography (sEMG) at rest and during non-nutritive sucking. Oral-motor skills were assessed with the Preterm Infant Oral Feeding Readiness Assessment Scale (POFRAS), and milk intake volume was recorded. RESULTS:All infants completed the intervention in March 2025 without adverse events. The sEMG amplitudes increased significantly for the masseter (20.96-52.79 μV, P < .001), zygomatic (29.07-69.56 μV, P < .001), and orbicularis oris (20.97-73.36 μV, P < .001). POFRAS scores improved from 12.10 ± 3.38 to 20.70 ± 5.60 (P < .001), and milk intake from 40.00 ± 6.66 mL to 45.00 ± 18.40 mL (P < .001). IMPLICATIONS FOR PRACTICE AND RESEARCH:PIOMI enhances orofacial muscle activity and feeding skills in premature infants. These findings support sEMG as an objective evaluation tool and provide preliminary evidence for larger clinical trials.
ABSTRACT Background: The ability of Neonatal Intensive Care Unit (NICU) nurses to recognize clinical cues indicating neonatal deterioration and make timely clinical decisions is essential for positive patient outcomes. How nurses progress from novice to expert in clinical cue recognition and decision making remains underexplored. Purpose: This qualitative descriptive study examines how cue recognition, clinical decision making, assessment techniques, and advocacy confidence evolve across novice, intermediate, and experienced NICU nurses. Methods: Individual semi-structured interviews were conducted with NICU nurses. Thematic analysis was used to identify patterns of cue detection and clinical decision making within and across experience levels. Results: Findings revealed a gradual shift from monitor dependence to behavioral assessment, protocol-based to individualized care, and reactive responses to predictive interventions. Novices relied on monitors, whereas experts prioritized subtle behavioral and physiological cues. Implications for Practice and Research: These findings emphasize the need for mentorship programs fostering pattern recognition, early advocacy, and diagnostic differentiation to accelerate NICU clinical expertise. Developing an assessment tool and signal detection trials to evaluate nurses' cue recognition and clinical decision-making skills could support structured staff development.
Background: Prolonged neonatal cardiopulmonary resuscitation (CPR) is critical for survival in cases of severe bradycardia due to asphyxia. High-performance CPR, emphasizing consistent compression depth and full recoil, improves survival rates. Purpose: This pilot study explored how environmental and provider-specific factors—including bed height, positioning, and anthropometry—affect the consistency of neonatal CPR using the 2-thumb technique. Methods: Twenty-two neonatal intensive care unit providers performed 2-minute CPR trials on a neonatal simulator under 2 conditions: self-selected bed height (“choice”) and standardized bed height (100 cm, “pre-set”). Compression depth and recoil were recorded using simulator sensors. Postural changes and onset of sway were assessed via video analysis. Results from the head-of-bed position were compared with data from a prior side-of-bed study. Results: Chest recoil decreased over time in both bed-height conditions, potentially compromising CPR effectiveness. Bed height did not impact the number of postural changes or time to sway with a head-of-bed approach. Compared to the side-of-bed position, head-of-bed placement resulted in fewer postural changes and delayed onset of sway. In the choice condition, taller providers and those with longer reach preferred higher bed heights. Implications for Practice and Research: The head-of-bed approach may enhance motor performance by allowing pelvic stabilization against the bed, limiting lower-joint motion, and improving stability. However, this position may impair chest recoil over time, potentially reducing CPR effectiveness. Further research is needed to optimize ergonomic factors influencing neonatal resuscitation performance.
ABSTRACT Background: Unfinished Nursing Care (UNC) in Neonatal Intensive Care Units (NICUs) is a critical determinant of infant outcomes. The Neonatal Extent of Work Rationing Instrument (NEWRI) measures the frequency of UNC but not the underlying reasons. Integrating the NEWRI with the UNC Survey (UNCS) to capture these reasons may help prevent or mitigate UNC. Purpose: To develop and validate a comprehensive tool for investigating UNC and related reasons in NICUs. Methods: A developmental and validation study was conducted in 2024 following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Part A of the NEWRI and Part B of the UNCS were integrated to develop the Italian version of the NEWRI with Reasons (NEWRI_IR). Nurses from 8 Italian NICUs (N = 342) were invited to participate. Descriptive and inferential analyses, Mokken Scale Analysis, and Confirmatory Factor Analyses were conducted. Results: A total of 198 nurses (57.9%) participated. The NEWRI_IR comprises 2 sections: Part A (25 items, care interventions) and Part B (15 items, reasons). Part A demonstrates strong scalability (H = 0.743), indicating a hierarchical structure among items. Part B revealed a 5-factor structure: “Human resources and workflow predictability,” “Communication issues,” “Material resources,” “Priority setting,” and “Human resources issues.” The most frequent UNC involved parental education and support, whereas inadequate nurse staffing and frequent interruptions were main reasons. Implication for Practice and Research: The NEWRI_IR is a psychometrically validated instrument for assessing the frequency and reasons for UNC in NICUs, supporting monitoring of care quality and guiding organizational interventions.
BACKGROUND:Pain assessment in preterm infants is challenging because of the absence of an objective reference standard, as self-report is not possible. Behavioral tools, including the COMFORTneo scale, are used in NICUs to assess pain and distress. Although interrater reliability (IRR) is generally adequate, its variation across gestational ages and rater experience remains unclear. PURPOSE:To examine the influence of gestational age and rater experience on the interrater reliability (IRR) of the COMFORTneo scale (primary aim) and to evaluate overall IRR (secondary aim). METHODS:We conducted 183 paired assessments of preterm infants by 21 graduated NICU nurses and 12 NICU nursing students, stratified into 5 gestational age groups (24-26, 27-29, 30-32, 33-35, ≥36 weeks). IRR was analyzed using intraclass correlation coefficients (ICC) and generalizability theory. Bootstrapping accounted for unequal distributions. RESULTS:Overall, IRR was excellent (ICC = 0.85), increasing with gestational age from 0.41 (24-26 weeks) to 0.92 (≥36 weeks). Item-level ICCs ranged from 0.39 (body movement) to 0.92 (respiratory response). Nursing students demonstrated slightly higher IRR (ICC = 0.86) compared with experienced nurses (ICC = 0.74). G-theory indicated that item characteristics explained more variance than rater differences (G = 0.56). IMPLICATIONS FOR PRACTICE:The COMFORTneo scale is reliable in moderately to late preterm infants but less consistent in extremely preterm infants. Structured training, including refresher sessions for graduated NICU nurses, potentially at intervals shorter than 5 years, is recommended. IMPLICATIONS FOR RESEARCH:Future studies should refine ambiguous items and explore complementary tools for extremely preterm infants.
BACKGROUND:Nicolau syndrome (NS) is a rare iatrogenic dermatologic reaction following intramuscular (IM) injections that is not well understood. It is especially uncommon in the extremely preterm neonatal population with this case being the first to document additional vascular findings. CLINICAL FINDINGS:A 24-week female infant weighing 623 g presented with a large, violaceous oval patch measuring 4.5 cm × 2.5 cm with an erythematous border on the left lateral thigh accompanied by dusky toes shortly after receiving routine IM injection of vitamin K. PRIMARY DIAGNOSIS:Once differential diagnoses were ruled out, an investigation of the IM vitamin K injection method and proximity of injection to initial onset of symptoms showed administration to be the cause. After review of the literature, NS was determined to be the most plausible diagnosis. INTERVENTIONS:To restore perfusion to the toes, the left leg was elevated, and a warm compress was applied to the contralateral foot. Bacitracin was administered topically, and the lesion was monitored over time. OUTCOMES:The lesion healed, leaving a linear scar circumscribed by a hypopigmented patch without secondary complications. PRACTICE RECOMMENDATIONS:As this is an iatrogenic event, development of standardized practice guidelines for IM injections in premature infants is recommended, especially in the extremely preterm and low birth-weight population. Vitamin K should continue to be administered through IM route as recommended by the American Academy of Pediatrics.
BACKGROUND:Extremely preterm infants are highly vulnerable to hypothermia because of immature thermoregulation and increased heat loss. Kangaroo mother care (KMC) is an evidence-based intervention associated with improved thermal stability, but evidence in extremely preterm infants during the first days of life remains limited. PURPOSE:To evaluate axillary temperature 60 minutes after initiating KMC in infants <28 weeks' gestation during the first 5 days of life, analyze temperature trends across sessions, and identify factors associated with thermal stability. METHODS:This prospective observational study was conducted as a secondary analysis of a noninferiority randomized controlled trial. Seventy extremely preterm infants admitted to a Level IIIC Neonatal Intensive Care Unit were included. Axillary temperature was measured at 5 time points during each KMC session, with the primary outcome assessed at 60 minutes. RESULTS:Seventy infants (mean gestational age 26 weeks) participated in 285 KMC sessions during the first 5 days of life. Infants maintained normothermia, with a mean axillary temperature of 36.83°C at 60 minutes. Temperature stability followed a cubic trend over time, with no differences by session order. A slight temperature decrease occurred during the first session, whereas subsequent sessions showed temperature increases. Environmental variables were not associated with thermal stability. IMPLICATIONS FOR PRACTICE AND RESEARCH:Early KMC is safe and effective for maintaining thermal stability in extremely preterm infants, including those with central lines. Attention during return transfer is essential to minimize heat loss. Larger studies are needed to confirm these findings and optimize early KMC protocols.
BACKGROUND:Cytomegalovirus (CMV) is one of the most common congenital infections identified in the neonatal period; however, testing remains inconsistent and can lead to increased health care costs and low diagnostic yield. PURPOSE:To optimize resource utilization and reduce overtesting in a level III neonatal intensive care unit (NICU) and general care nursery (GCN) among neonates classified as small for gestational age (SGA) or with intrauterine growth restriction (IUGR). METHODS:An interprofessional team implemented a standardized congenital CMV testing guideline supported by an electronic medical record-based best practice advisory (BPA) in the NICU and GCN. Education was provided to advanced practice providers and physicians, and the guideline was accessible through the hospital intranet. Weekly audits were conducted over a 12-week period (November 18, 2024-February 7, 2025) to evaluate BPA-identified neonates. Measures included IUGR and SGA classification, presence of physical signs or additional risk factors, CMV testing and positivity rates, and guideline adherence. RESULTS:Forty-one neonates triggered the BPA for testing consideration. Nine infants (21%) exhibited a physical sign, exclusively head circumference less than the 10th percentile. Fifteen infants (36%) were tested for isolated IUGR and/or SGA without physical signs or additional risk factors. Twenty-four neonates (59%) underwent urine CMV polymerase chain reaction testing, with zero positive results. Guideline adherence was 90% (n = 37). IMPLICATIONS FOR PRACTICE AND RESEARCH:A standardized, risk-based congenital cytomegalovirus testing guideline improved testing consistency and reflected evidence of low diagnostic yield in asymptomatic infants. Future evaluation is needed to assess sustainability and refine testing criteria.
BACKGROUND:Neonatal respiratory outcomes remain leading drivers of neonatal intensive care unit (NICU) morbidity, mortality, and prolonged hospitalization, underscoring the need for accurate early risk prediction through artificial intelligence (AI) and machine learning (ML) approaches. PURPOSE:To conduct a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review synthesizing AI/ML models predicting neonatal respiratory outcomes through a Life Course Health Development (LCHD) lens, examining whether models incorporate developmental timing, cumulative processes, and contextual factors. DATA SOURCES:PubMed, Embase, and Web of Science were searched from January 1, 2014, to July 18, 2025. STUDY SELECTION:Included peer-reviewed studies developing or validating AI/ML prediction models for neonatal respiratory outcomes with performance metrics. Excluded non-ML regression, non-original research, and non-English studies. Of 4319 records initially identified, 1780 unique records were screened, 33 underwent full-text review (0.76%); 16 met selection criteria (0.37%). DATA EXTRACTION:Two reviewers independently extracted study characteristics, inputs, algorithms, validation strategies, and performance metrics. Risk of bias was assessed using PROBAST + AI. Disagreements were resolved by consensus. RESULTS:Studies addressed bronchopulmonary dysplasia (n = 8), respiratory distress syndrome (n = 4), apnea of prematurity (n = 3), and massive pulmonary hemorrhage (n = 1). Discrimination was strong in internal validation (several models with an area under the receiver operating characteristic curve ≥0.85). External validation was rare (2/16); calibration reporting was sparse. No studies predicted postdischarge respiratory outcomes or included comprehensive determinants of health. IMPLICATIONS FOR PRACTICE AND RESEARCH:Although ML models show promise for NICU risk stratification, responsible clinical adoption requires multisite external validation, routine calibration, and nursing-informed designs incorporating development context. See Video Abstract, Supplemental Digital Content.
BACKGROUND:High-risk newborns often present with clinical deterioration that is difficult to detect. In neonatal intensive care units (NICUs), conventional physiological monitoring and manual clinical assessments are associated with substantial operational burdens and high false alarm rates. With the surge in clinical data, frontline physicians and nurses need to screen for effective information to assist in decision making. Therefore, there is an urgent need to explore the requirements for data screening and automated information support in the early warning system for newborns. PURPOSE:This study aimed to explore the clinical demand for an intelligent early warning system and identify the primary obstacles clinical team face in the early recognition of condition changes among high-risk neonates. These findings provide a reference for improving clinical strategies and system designs. METHODS:A descriptive, qualitative research approach was used. Semi-structured interviews were conducted with 13 NICU healthcare professionals. Data were systematically analyzed using a directed content analysis method. RESULTS:The interview content was synthesized into 3 primary themes and 8 subthemes: (1) high-risk factor profiling and early warning signals, (2) obstacles and challenges in identifying early disease changes, and (3) expectations regarding the functionalities of an information-intelligent system. IMPLICATIONS FOR PRACTICE AND RESEARCH:Nursing and hospital management should collaboratively advance staff training, information system upgrades, and clinical workflow optimization. Training should focus on enhancing staff's ability to identify risks, the system must ensure efficient information flow and timely alerts, and workflow optimization is crucial to ensure a rapid clinical response after risk identification.
BACKGROUND:Intensive care unit (ICU) nurses improve patient outcomes through respiratory weaning protocols, yet this is not standard practice in the neonatal ICU (NICU). Infants born extremely prematurely, <28 weeks gestational age, are at risk for the development of severe bronchopulmonary dysplasia (BPD). Reducing exposure to invasive mechanical ventilation (iMV) can reduce the severity of BPD, yet it remains a challenge. PURPOSE:This quality improvement initiative assessed the effect of optimizing nurse-led rounds scripts on the interdisciplinary rounding structure and explored iMV time among infants in a BPD cohort. The 3 objectives were education, script compliance, and iMV time. The project was guided by the Plan-Do-Study-Act cycle model and Lewin's Change Theory. Implementation occurred in a level IV NICU within a single children's hospital. The population included 240 NICU nurses, 57 neonatal nurse practitioners, and 118 neonatologists caring for a cohort of 18 patients with BPD. METHODS:Nurses-led rounds through an optimized respiratory script for a cohort of patients with BPD. After 90 days of implementation, nurses' confidence, autonomy, and respiratory knowledge were compared. iMV time for the patients with BPD was retrospectively reviewed. RESULTS:Daily script usage improved to 61% by day 90. Education was completed by 99% of the nurses. The nurse's confidence, knowledge, and sense of autonomy all increased. IMPLICATIONS FOR PRACTICE AND RESEARCH:These results indicate that nurse-led rounds scripts benefit NICU nurses' leadership, improve interdisciplinary collaboration, and improve respiratory outcomes for NICU patients.
Early-onset neonatal sepsis (EOS) remains a diagnostic challenge because clinical signs are nonspecific and blood cultures, although the diagnostic gold standard may yield false-negative results due to low blood volumes or maternal antibiotic exposure. To determine whether serum melatonin levels differ between term neonates with clinically suspected EOS and healthy controls, and to evaluate the diagnostic performance of melatonin relative to standard inflammatory markers. This prospective case–control study included 84 term infants: 42 with clinically suspected EOS, defined according to the Centers for Disease Control and Prevention and National Institute for Health and Care Excellence criteria, and 42 controls. Blood cultures, complete blood count, C-reactive protein, and serum melatonin levels measured by enzyme-linked immunosorbent assay were obtained within 24 hours of life before antibiotic initiation. Receiver operating characteristic (ROC) analyses were performed for all suspected EOS cases and separately for culture-confirmed EOS. Eleven infants (26.2%) in the suspected EOS group had positive blood cultures. Mean melatonin levels were significantly lower in suspected EOS than in controls (193.5 ± 61.8 vs 231.6 ± 71.1 pg/mL; P = .010). However, melatonin levels did not differ significantly between culture-positive and culture-negative suspected EOS cases. ROC analysis for suspected EOS yielded an area under the curve of 0.628; a melatonin cutoff of 242 pg/mL provided 81% sensitivity but limited specificity (45.2%). ROC performance for culture-confirmed EOS was modest. Melatonin demonstrates limited diagnostic specificity and should be interpreted only as a supportive marker within a multimodal evaluation strategy.
BACKGROUND:Developmentally supportive care (DSC) for preterm infants is essential for promoting optimal growth and neurodevelopment in neonatal intensive care units (NICUs). However, successful implementation of DSC depends not only on institutional systems but also on individual nurse attributes. PURPOSE:This study aimed to examine the influence of self-leadership, emotional intelligence (EI), and nursing professionalism on DSC competency among NICU nurses. METHODS:A descriptive cross-sectional survey was conducted with 130 NICU nurses from 8 hospitals in South Korea. Data were collected using validated instruments measuring self-leadership, EI, nursing professionalism, and DSC competency. Statistical analyses included descriptive statistics, independent t-tests, ANOVA, Pearson correlations, and multiple linear regression. RESULTS:The mean DSC competency score was 2.83 of 4, with "professional development" scoring the lowest among its subdomains. DSC competency levels were higher among nurses who were married, had children, had longer clinical experience, were assigned more than 4 patients, and reported higher monthly income. EI (β = 0.41, P < .001), nursing professionalism (β = 0.28, P < .001), more than 10 years of total clinical experience (β = 0.27, P = .011), and self-leadership (β = 0.25, P = .003) were identified as significant predictors of DSC competency, explaining 69% of the variance. IMPLICATIONS FOR PRACTICE AND RESEARCH:Findings suggest that psychosocial attributes-particularly EI-are critical enablers of developmental care. Interventions aimed at fostering EI, nursing professionalism, and self-leadership may provide a useful framework for future research examining strategies to support DSC competency in NICU settings.
BACKGROUND:Bedside nurses in the neonatal intensive care unit (NICU) experience unique and challenging work, which can result in burnout for reasons that may differ from other healthcare providers. PURPOSE:The aim was to synthesize existing literature related to NICU nurse burnout to describe its characteristics, determinants, and implications. DATA SOURCES:Supported by a medical librarian, 5 databases were searched (PubMed/MEDLINE, CINAHL, ProQuest Nursing, PsycINFO, and Cochrane Reviews) with no date boundaries. STUDY SELECTION:Methodological guidance from both PRISMA-ScR and Joanna Briggs Institute was used in the scoping review. From the 342 screened articles, 26 met inclusion criteria. DATA EXTRACTION:We used Covidence to perform an independent two-person review strategy with a piloted and calibrated data extraction form. RESULTS:Burnout was more common among younger and less experienced NICU nurses. Positive work environments and good interpersonal relationships reduced burnout. Across the articles using the Maslach Burnout Inventory, depersonalization was low (M = 4.2) and emotional exhaustion was low to moderate (M = 17.4). Mean personal accomplishment scores (M = 29.4) indicated high burnout in this dimension. IMPLICATIONS FOR PRACTICE AND RESEARCH:A positive work environment, supportive management, and access to mental health resources for burnout may help to reduce burnout, especially for novice nurses, those with concurrent mental health challenges, and during distressing patient care events. The identified knowledge gaps include a lack of longitudinal evidence, sparse interventional outcomes, and a paucity of correlational studies about how nursing care approaches may affect burnout.
BACKGROUND:Few studies have examined how empathy develops in neonatal intensive care units (NICUs) as nurses experience negative outcomes in end-of-life care delivery (eg, burnout, moral conflict, and psychological distress). Various characteristics of neonatal care contribute to frequent infant deaths and nurse emotional strain, rendering knowledge of how empathy evolves essential for improving end-of-life care and NICU nurse well-being nationwide. PURPOSE:To explore the experiences of NICU nurses providing end-of-life care for infants in South Korea, focusing on the impact of recurrent exposure to infant deaths. METHODS:In this qualitative descriptive study, semi-structured interviews were conducted with 11 nurses from a tertiary Level IV NICU in Seoul, South Korea, each with ≥6 months of experience caring for terminally ill infants and having experienced at least 2 infant deaths. Reflective thematic analysis of Braun and Clarke was used for analysis. RESULTS:Three main themes emerged: (1) Providing emotionally detached end-of-life care in the NICU; (2) Developing empathy through end-of-life care; and (3) Becoming a more empathetic professional caregiver. IMPLICATIONS FOR PRACTICE AND RESEARCH:Empathy is critical for high-quality neonatal end-of-life care. Structured educational and emotional support is needed to foster empathy and promote compassionate, family-centered practices.
