Neonatal intensive care unit discharge education interventions and their effects on maternal sensitivity and neurocognitive development of premature infants: a protocol for a systematic review

Abstract

BACKGROUND: Premature babies often suffer fatal respiratory complications due to physiological brain immaturity and insufficient levels of surfactants in the lungs. To ensure their physiological stability and prevent perinatal death, all premature babies are recommended to receive enhanced life-saving care and monitoring in a neonatal intensive care unit. However, long-term hospital stays in the NICU may result in suboptimal mother-infant bonding, neonatal distress, neurological deficits, and severe psychosocial and behavioral complications. Research suggests that early intervention and comprehensive post-discharge health education can effectively support mothers and thus reduce these poor outcomes. However, there is significant variation in the design of interventions, the key components, the timing, and the measurement of the outcomes. METHODS: This review will examine the educational discharge interventions provided to mothers whose babies were born below 37 weeks and admitted to the NICU. The review will include a search of studies in the EMBASE, CINAHL, Global Health, PubMed, and SCOPUS databases. We will include RCTs and controlled quasi-experimental studies published in English from the database's inception to November 2024. The Joanna Briggs Institute checklist for quasi-experimental research and the Cochrane Risk of Bias tool (RoB-1) for RCTs will be used to evaluate the risk of bias. Data extraction will be done by two independent reviewers using Covidence software. Data synthesis will be done using the modified narrative synthesis approach. Quantitative data reported in three or more studies will be pooled for meta-analysis using IBM SPSS version 29. To determine the magnitude of the effect size of the intervention, we will compute odds ratios and weighted mean differences, along with their respective 95% confidence intervals. DISCUSSION: This systematic review will examine the impact of health education interventions in neonatal intensive care mothers on maternal bonding and infant neurodevelopmental outcomes. The results will inform the development of the most effective discharge education program, focusing on maternal-infant interaction, maternal sensitivity, and infant neural cognitive development for mothers of preterm infants graduating from the NICU. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024575785.