Parental participation in the care of hospitalized neonates in low- and middle-income countries: A systematic review and meta-analysis

Introduction To determine the effect of parental participation in hospital care on neonatal and parental outcomes in low- and middle-income countries (LMICs) and to identify the range of parental duties in the care of hospitalized neonates in LMICs. Methods We searched CINAHL, CENTRAL, LILACs, MEDLINE, EMBASE and Web of Science from inception to February 2022. Randomized and non-randomized studies from LMICs were eligible if parents performed one or more roles traditionally undertaken by healthcare staff. The primary outcome was hospital length-of-stay. Secondary outcomes included mortality, readmission, breastfeeding, growth, development and parental well-being. Data was extracted in duplicate by two independent reviewers using a piloted extraction form. Results Eighteen studies (eight randomized and ten non-randomized) were included from seven middle-income countries. The types of parental participation included hygiene and infection prevention, feeding, monitoring and documentation, respiratory care, developmental care, medication administration and decision making. Meta-analyses showed that parental participation was not associated with hospital length-of-stay (MD −2.35, 95% CI −6.78–2.07). However, parental involvement was associated with decreased mortality (OR 0.46, 95% CI 0.22–0.95), increased breastfeeding (OR 2.97 95% CI 1.65–5.35) and decreased hospital readmission (OR 0.36, 95% CI 0.16–0.81). Narrative synthesis demonstrated additional benefits for growth, short-term neurodevelopment and parental well-being. Ten of the eighteen studies had a high risk of bias. Conclusion Parental participation in neonatal hospital care is associated with improvement in several key neonatal outcomes in middle-income countries. The lack of data from low-income countries suggests that there remains barriers to parental participation in resource-poor settings. Systematic review registration [ https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=187562 ], identifier [CRD42020187562].

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