Peer-reviewed article
Delivering nurturing care for small and sick newborns in facility-based settings: A scoping review of implementation approaches
Arti Maria, Manish Pal, Manish Singh Chundawat, Aarushi Mavi, Hamza Salah et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This scoping review examined how nurturing care interventions are delivered to small and sick newborns in hospital settings globally. The review found 13 studies showing that interventions like pain management techniques, changes to the hospital environment, and family-centred practices can reduce newborn stress and improve outcomes. Key success factors included committed leadership, trained staff, and family involvement, though barriers like staff turnover and lack of clear protocols limited implementation. The evidence base is growing but remains incomplete, with gaps in reporting how well these interventions are sustained over time.
Key points
- Twelve of thirteen studies addressed safety and security; nine addressed responsive caregiving; eight addressed nutrition and early learning opportunities; only one addressed good health
- Non-pharmacological pain management, environmental modifications, caregiver-led practices and digital training reduced neonatal stress, improved feeding readiness, and shortened hospital stays
- Enablers of implementation included leadership commitment, trained staff, and family engagement
- Barriers included environmental stressors, fragmented protocols, and staff turnover
- Implementation and sustainability outcomes were inconsistently reported across studies
Limitations
The review includes only English-language publications from 2015 onwards, which may exclude relevant work from other regions or languages. The fragmented reporting across studies makes it difficult to compare effectiveness or understand which implementation strategies work best in different contexts.
Abstract
Background Early-life nurturing care (NC) interventions are crucial to shape developmental trajectories of small and sick newborns, facing adverse experiences in neonatal care units (NCUs). However, NC implementation remains inconsistent globally. This review catalogued interventions aligned with Nurturing Care Framework (NCF), described implementation strategies, and explored barriers and enablers. Methods Following Joanna Briggs Institute guidance and PRISMA-ScR, we searched four databases (PubMed, Scopus, CINAHL, and Campbell Collaboration) for English-language sources (January 2015 to April 2025). Two reviewers independently screened, selected, and charted data aligned with NCF domains, resolving disagreements with the third reviewer. Findings were synthesized using descriptive mapping and realist-informed context-mechanism-outcome configurations. Results Of 1,125 articles screened, 13 studies were selected (seven from low- and middle-income countries; 10 randomized controlled trials, three observational; five implementation research, one quality improvement). NCF components frequently addressed were safety and security (n=12), responsive caregiving (n=9), adequate nutrition (n=8), and opportunities for early learning (n=8); good health was least addressed (n=1). Interventions like non-pharmacological pain management, environmental modifications, caregiver-led practices and digital training, reduced neonatal stress, improved feeding readiness, and shortened hospital stays. Enablers included leadership commitment, trained staff, and family engagement. Barriers included environmental stressors, fragmented protocols, and staff turnover. Implementation and sustainability were inconsistently reported. Conclusion Evidence on facility-based NC for small and sick newborns is growing but remains fragmented, with limited reporting on strategies, fidelity, and sustainability. Future studies should use implementation science frameworks and prioritize workforce, infrastructure, and policy support to embed NC within NCU protocols. Registration Open Science Framework (OSF) protocol: https://osf.io/aqpyw Reporting PRISMA-ScR checklist and flow diagram are provided in the supplementary materials.