Parental engagement and early interactions with preterm infants during the stay in the Neonatal Intensive Care Unit: protocol of a mixed-method and longitudinal study

Introduction: The preterm infants’ developmental outcomes depend on both biological and environmental risk factors. The environmental factors include prolonged parental separation, less exposure to early mother/father-infant interactions and the parents’ ability to respond to the trauma of premature birth. In the case of premature birth, the father’s ability to take an active part in the care of the infant from the start is essential. The parents’ emotional closeness to the preterm infant hospitalized in the Neonatal Intensive Care Unit (NICU) –through touch, affectionate talk, visual contact and facial affect–may be crucial to the well-being of the newborn, the development of mutual regulation, the establishment of a functioning parent-infant affective relationship, and the parents’ confidence in their ability to provide care for their baby. Methods and analysis: This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Northern Italy for a duration of 18 months; (2) 3+3 min video recordings of mother-infant and father-infant interaction in the NICU; (3) a semi-structured interview with fathers during the infants’ hospital stay; (4) 3+3 min video recordings of mother-infant and father-infant face-to-face interaction in the laboratory at 4 months of corrected age; (5) a self-report questionnaire for parents on depression and a questionnaire on the quality of the couple relationship at the approximate times of the video recording sessions. Ethics and dissemination: The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (A) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (B) the influence of maternal/paternal social stimulation on the infant behavioral states; (C) the quality and modalities of paternal support to the partner, and possible influences on the mother-infant relationship. Strengths and limitations of this study: - This is one of a small number of studies focused on maternal/paternal communicative behaviors addressed spontaneously to the preterm infant hospitalized in the NICU, and their effects on the infant’s behavioral states. - Results from this project will increase the very scant knowledge about the presence of early interactive contingencies between mother/father and the preterm infant in the NICU, and their possible predictive role of positive outcomes in mother-infant and father-infant relationship. - Findings will be limited to the experiences of Italian parents.