This study conducts a systematic review and meta-analysis of the randomized-controlled clinical trials (RCTs) of attachment- and relationship-based interventions in the NICU. A systematic search of the PubMed, MEDLINE, Embase (OVID), PsycINFO, and CINAHL databases and the Cochrane Database of Systematic Reviews was conducted in February 2021. Of the 32,904 studies examined, 15 were identified as relevant, and 10 RCTs were eligible for meta-analysis. Cochrane’s risk of bias tool was used to assess the quality of the trial reporting. Interventions were categorized as (1) parent–infant interactions, (2) parent education, and/or (3) support through qualitative synthesis. The attachment- or relationship-based intervention was effective in relieving maternal traumatic stress, maternal depression, infant weight growth, and infant development. Subgroup analyses suggested that interventions significantly improved sub-domains of mothers’ and children’s interactive behavior. Tailored, staged interventions may contribute to better health outcomes in preterm infants and their families.

Mothers of infants hospitalized in neonatal intensive care units (NICUs) need to be recognized as essential partners of the care team as their presence and involvement are key to infants' health and developmental outcomes. Addressing mothers' perceived needs is beneficial for the improvement of supportive nursing care; however, little qualitative research on their unmet needs has been conducted in South Korea. This study assessed mothers' perspectives on their NICU experiences and their unmet needs within the South Korean cultural context. A cross-sectional, multicentered, secondary analysis study was conducted using the written responses to an open-ended questionnaire. Of the 344 NICU-experienced mothers, 232 throughout South Korea (seven cities and five provinces) voluntarily completed the questionnaire via smartphone-based or web-based surveys. Their narrative responses were analyzed using thematic content analysis guided by the critical incident technique. Four themes emerged. NICU-experienced mothers of preterm infants referred to the "family-friendly environment" (16.4%) as a positive experience. The greatest unmet need was "relationship-based support" (58.2%), followed by "information and education-based support" (20.0%) and "system-level challenges" (5.4%). The importance of creating a family-friendly NICU environment should be emphasized by ensuring 24-hour unrestricted access and encouraging active parental involvement in infant care, as well as actively supporting NICU families through supportive words and actions. The assurance of antiinfection management and better staffing levels should be fundamentally guaranteed to NICU staff.

Background: Attachment in the parent-infant dyads is fundamental for growth and development of children born prematurely. However, the natural process of attachment is interrupted just after preterm birth, and emotional and physical detachment, limited social interaction, and a traumatic, technologically heavy environment in a neonatal intensive care unit (NICU) may result in impaired attachment or bonding. To our knowledge, few studies have evaluated the effectiveness of interventions aimed at enhancing attachment, bonding, and relationships between parents and their preterm infants during the infant’s hospitalization in the NICU. This study aims to perform a comprehensive systematic review and a meta-analysis survey of the effects of attachment- and relationship-based interventions in the NICU. Method: A comprehensive literature review will be conducted in the following databases: MEDLINE, CINAHL, PubMed, EMBASE (OVID), Scopus, PsycINFO (OVID), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science. Selected studies will be published in English, in the last 20 years, from 1999 onwards. All studies of randomized controlled trials (e.g., parallel groups, cluster) will be included. We will consider studies evaluating attachment- and relationship-based interventions (e.g., skin-to-skin contact, parental involvement in infant care) versus a comparator (standard of care). The primary outcome will be maternal attachment. Secondary outcomes will include infants’ growth and development, family health, and parenting experience. Data extraction from eligible studies will be conducted independently by two experts who will compare their data. The Cochrane risk of bias tool will be applied to the selected studies. If data permits, we will conduct random effects meta-analysis where appropriate. Subgroup and additional analyses will be conducted to explore the potential sources of heterogeneity considering gender of parents, infants’ sex, and gestational age. Data synthesis will be carried out using the RevMan 5.3 software. Publication bias will be assessed with the graphical funnel plot method and the Egger test. The quality of the evidence will be rated using the methods of the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. Discussion: The results of this systematic review will discuss the types of attachment- or relationship-based interventions that are effective for facilitating family health outcomes and the babies’ growth and development and will contribute to establishing new evidence in neonatal and family-centered care by providing scientific guidance for clinical practice and further research. Systematic review registration: PROSPERO CRD42019145834

Kim AR, et al. Korean J Women Health Nurs. 2015 Dec;21(4):308-320. http://dx.doi.org/10.4069/kjwhn.2015.21.4.308

Purpose: Preterm birth and admission to a neonatal intensive care unit (NICU) can disrupt the parent-infant bonding relationship. Although neonatal nurses are in the best position to support maternal postpartum bonding in the NICU, few qualitative studies have described their challenges, strategies, and lived experiences. Methods: This study aimed to explore and understand the experiences and perspectives of nurses supporting infants hospitalized in the NICU and their families in relation to the bonding process. We conducted a qualitative study using interpretive phenomenological analysis with 12 in-depth, semi-structured interviews recorded and transcribed verbatim between April and November 2018. We thematically analysed the data using NVivoTM software. Results: Two themes emerged: (1) Being a bridge between separated mothers and infants (five subthemes); (2) Challenges in providing supportive care for maternal postpartum bonding in the NICU (three subthemes). Conclusions: Nurses have a variety of experiences regarding maternal postpartum bonding; however, the clinical reality of NICUs limits support for bonding formation. Although nurses face challenges (e.g., institutional policies, insufficient resources, training) when supporting maternal postpartum bonding, they act as the bridge between mothers and infants, becoming advocates for NICU families and taking care of their growth and developmental needs as caregivers.