NICU Virtual Family-Centered Rounds: A Cluster Randomized Controlled Trial - PubMed (original) (raw)

Randomized Controlled Trial

NICU Virtual Family-Centered Rounds: A Cluster Randomized Controlled Trial

Jennifer L Rosenthal et al. Pediatrics. 2026.

Abstract

Background and objective: The use of telehealth to bring a family member virtually to the bedside for family-centered rounds (FCR) is a promising strategy to increase family members' access. We aimed to evaluate the impact of offering families the option to use virtual FCR in the neonatal intensive care unit (NICU) on parental and neonatal outcomes.

Methods: This 2-arm cluster randomized controlled trial assigned families of hospitalized infants to the option of using virtual FCR (intervention) or to usual care (control). Intervention families could also attend FCR in person (usual care). All eligible families of infants who were admitted to this single-site neonatal intensive care unit during the study period were included. Outcomes included FCR attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth.

Results: From March 2023 to 2024, 486 families were randomized (325 intervention, 161 control). Infants in the intervention arm were estimated to have 4.81 (95% CI 3.65-6.32) times the parent attendance rate of infants in the control arm (unadjusted incidence rate ratio: 4.62 [95% CI 3.40-6.28]). The intervention arm had 0.37 (95% CI 0.18-0.75) times the adjusted odds of a 30-day emergency department revisit compared with the control arm (unadjusted odds ratio: 0.48 [95% CI 0.25-0.91]). No statistically significant positive intervention effects were observed for other secondary outcomes.

Conclusions: Offering virtual FCR increased parent attendance and reduced 30-day emergency department revisits among NICU infants.

Copyright © 2026 by the American Academy of Pediatrics.

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Conflict of interest statement

Conflict of interest disclosures: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1:

Figure 1:. Trial Flowchart

FCR – family-centered rounds; NICU – neonatal intensive care unit; CPS – child protective services a Reasons for ineligibility of parent/guardian: 38 families (43 infants) with no parent/guardian with English proficiency; 3 families (3 infants) with no parent/guardian aged 18 years or older; 1 family (1 infant) no un-incarcerated parent/guardian b Infant admitted and discharged on a weekend or during other periods of time when a research assistant was not working c Identification of the lack of an eligible parent or guardian occurred after study arm allocation d 278 families (278 infants) assigned to the intervention group had a nonzero number of possible FCR encounters; 139 families (139 infants) assigned to the control group had a nonzero number of possible FCR encounters e Restrictions placed after study arm allocation

Figure 2:

Figure 2:. Subgroup Analyses of the Intervention Effect on Family-Centered Rounds Parent Attendance Rate

FCR – family-centered rounds; CI – confidence interval. Neighborhood health condition quartiles based on the California Healthy Places Index. Ethnicity, race, transportation insecurity, internet access, employment, device access, and internet access describe the birthing parent’s characteristics collected via survey. Logarithmic scale is employed on the horizontal axis. Adjusted rate ratios estimated in separate Poisson regression models, each model adjusting for birthing parent’s race, ethnicity, education, employment, transportation insecurity, housing, and neighborhood health condition. Point estimates favor the intervention, compared to the control, for all subgroups except for Native Hawaiian or Other Pacific Islander, those with access to a desktop/laptop only, and those with the lowest digital literacy score (0).

Figure 3:

Figure 3:. Impact of Virtual FCR Intervention on Closing FCR Attendance Disparities

P-values reflect the comparison between relative attendance rates for Subgroups (A)-to-(B) – expressed as ratio of incidence rate ratios (IRR) – within each figure. P-value obtained from an interaction term of the intervention with the variable of interest: (3a) race/ethnicity and (3b) neighborhood health. Dashed line indicates parity. Race and ethnicity describe the birthing parents’ self-reported identity collected by survey; birthing parents who did provide their race/ethnicity data via survey are not included in Figure 3a. Neighborhood health condition defined by the California Healthy Places Index, whereby worse health is the lower three quartiles and better health is the highest quartile.

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