{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:58:41Z","timestamp":1764597521340,"version":"3.46.0"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Introduction: Preterm birth and neonatal intensive care unit (NICU) admission may elevate parental stress and impair early parent\u2013infant interaction. In low-resource settings, where staff and resources are limited, parental education programmes are often also limited, further complicating care engagement. This study piloted the NeuroSense PremmieEd parenting educational programme to assess its preliminary impact on maternal stress and knowledge in a South African public-sector NICU. Objectives: This study aimed to pilot a contextually relevant parenting education intervention to enhance parental understanding of preterm infant behaviour, strengthen parents\u2019 capacity to interpret and respond sensitively to infant cues, and reduce parental stress during NICU admission. Methodology: This sequential cohort pilot study involved 60 mothers of preterm infants (gestational age, 24\u201336 weeks) admitted to two comparable NICUs. Mothers (aged 18\u201345 years) were allocated to three groups. Arm 1 received standard care (n = 20), Arm 2 received a printed educational booklet (n = 20), and Arm 3 received the booklet plus a facilitated education session (n = 20). Pre- and post-intervention data were collected using the Knowledge of Preterm Infant Behaviour (KPIB) questionnaire and the Parental Stressor Scale: NICU (PSS:NICU). Descriptive statistics were used to explore differences between arms. Results: Knowledge scores measured with the KPIB tool showed a positive trend in all groups, with the greatest improvement observed in Arm 3; however, these changes were not statistically significant (p = 0.176). Maternal stress measured using the PSS:NICU increased significantly over time across all groups (F(1, 57) = 8.40, p = 0.005), with Arm 3 consistently reporting the lowest stress at both timepoints. Discussion: The facilitated intervention was associated with a trend towards improved maternal knowledge of preterm infant behaviour. This pilot study highlighted the potential of structured and culturally relevant education to support early parenting in a public-sector NICU in South Africa. Maternal stress levels remained high across all groups. While this finding may be due to parents\u2019 experience of changes in infant medical condition, fatigue, and other factors, these were not investigated in this study and therefore warrant further exploration in future work. Conclusions: The NeuroSense PremmieEd programme shows promise in improving maternal understanding of preterm infant behaviour. The results highlight the need for further adaptation of content delivery, inclusion of diverse populations (e.g., by preterm category) and scalable, low-resource approaches to improve engagement and long-term outcomes.<\/jats:p>","DOI":"10.3390\/children12121636","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:03:02Z","timestamp":1764594182000},"page":"1636","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pilot Implementation of the NeuroSense PremmieEd Parenting Educational Programme for Parents with Infants in the Neonatal Intensive Care Unit: A Sequential Cohort Design"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2468-5687","authenticated-orcid":false,"given":"Welma","family":"Lubbe","sequence":"first","affiliation":[{"name":"Division of Developmental Paediatrics, Department of Paediatrics & Child Health, Red Cross War Memorial Children\u2019s Hospital, Neuroscience Institute, University of Cape Town, Cape Town 7700, South Africa"},{"name":"NuMIQ Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom 2531, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0276-9660","authenticated-orcid":false,"given":"Kirsten A.","family":"Donald","sequence":"additional","affiliation":[{"name":"Division of Developmental Paediatrics, Department of Paediatrics & Child Health, Red Cross War Memorial Children\u2019s Hospital, Neuroscience Institute, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"S\u00e9assau, A., Munos, P., Gire, C., Tosello, B., and Carchon, I. (2023). Neonatal care unit interventions on preterm development. Children, 10.","DOI":"10.3390\/children10060999"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Shaw, R.J., Givrad, S., Poe, C., Loi, E.C., Hoge, M.K., and Scala, M. (2023). Neurodevelopmental, mental health, and parenting issues in preterm infants. Children, 10.","DOI":"10.3390\/children10091565"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"55","DOI":"10.11604\/pamj.2023.44.55.34344","article-title":"Hospitalization in neonatal intensive care unit: Parental anxiety and satisfaction","volume":"44","author":"Voulgaridou","year":"2023","journal-title":"Pan Afr. Med. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jnn.2020.09.009","article-title":"Recognizing and Mitigating Infant Distress in Neonatal Intensive Care Unit (NICU)","volume":"27","author":"Givrad","year":"2020","journal-title":"J. Neonatal Nurs."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Naeem, N., Zanca, R.M., Weinstein, S., Urquieta, A., Sosa, A., Yu, B., and Sullivan, R.M. (2022). The neurobiology of infant attachment-trauma and disruption of parent\u2013infant interactions. Front. Behav. Neurosci., 16.","DOI":"10.3389\/fnbeh.2022.882464"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zanta, N.C., Assad, N., and Suchecki, D. (2023). Neurobiological mechanisms involved in maternal deprivation-induced behaviours relevant to psychiatric disorders. Front. Mol. Neurosci., 16.","DOI":"10.3389\/fnmol.2023.1099284"},{"key":"ref_7","first-page":"10578","article-title":"The effectiveness of parental education programs within neonatal intensive care units: A systematic review","volume":"2","author":"Springer","year":"2023","journal-title":"Res. Directs Ther. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kim, S., and Kim, A.R. (2022). Attachment- and relationship-based interventions during NICU hospitalization for families with preterm\/low-birth weight infants: A systematic review of rct data. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19031126"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e220537","DOI":"10.1590\/interface.220671","article-title":"Strategies and educational needs of parents of premature infants in a third level hospital in Cali, Colombia","volume":"27","year":"2023","journal-title":"Interface"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.nwh.2021.01.007","article-title":"How a frightened mother of a preterm newborn eventually flourished","volume":"25","author":"Hendricks","year":"2021","journal-title":"Nurs. Women\u2019s Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"390","DOI":"10.4038\/sljch.v49i4.9274","article-title":"How to Prepare Your Preterm Baby before Discharge","volume":"49","author":"Kristiawati","year":"2020","journal-title":"Sri Lanka J. Child Health"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"M\u00f6ller, E.L., de Vente, W., and Rodenburg, R. (2019). Infant crying and the calming response: Parental versus mechanical soothing using swaddling, sound, and movement. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0214548"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Polizzi, C., Perricone, G., Morales, M.R., and Burgio, S. (2021). A study of maternal competence in preterm birth condition, during the transition from hospital to home: An early intervention program\u2019s proposal. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168670"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1053\/j.nainr.2010.12.002","article-title":"Parent education: The cornerstone of excellent neonatal nursing care","volume":"11","author":"Baker","year":"2011","journal-title":"Newborn Infant Nurs. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.earlhumdev.2014.08.019","article-title":"Parents as practitioners in preterm care","volume":"90","author":"Jiang","year":"2014","journal-title":"Early Hum. Dev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.pedn.2021.01.023","article-title":"The experiences of parent dyads in the neonatal intensive care unit: A qualitative description","volume":"60","author":"Loewenstein","year":"2021","journal-title":"J. Pediatr. Nurs."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1891\/0730-0832.36.1.18","article-title":"Comprehensive NICU parental education: Beyond baby basics","volume":"36","author":"Mosher","year":"2017","journal-title":"Neonatal Netw."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"59","DOI":"10.4103\/jehp.jehp_514_22","article-title":"The effect of instructing mothers in attachment behaviors on short-term health outcomes of premature infants in NICU","volume":"12","author":"Abbasinia","year":"2023","journal-title":"J. Educ. Health Promot."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Carozza, S., and Leong, V. (2021). The role of affectionate caregiver touch in early neurodevelopment and parent\u2013infant interactional synchrony. Front. Neurosci., 14.","DOI":"10.3389\/fnins.2020.613378"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1037\/h0100514","article-title":"The benefits of attachment parenting for infants and children: A behavioral developmental view","volume":"16","author":"Miller","year":"2010","journal-title":"Behav. Dev. Bull."},{"key":"ref_21","first-page":"58","article-title":"Clinical intervention involving parents in their preterm infant\u2019s care to promote parental sensitivity: A case study","volume":"27","author":"Aita","year":"2020","journal-title":"J. Neonatal Nurs."},{"key":"ref_22","first-page":"15","article-title":"Understanding kangaroo care and its benefits to preterm infants","volume":"6","author":"Disher","year":"2015","journal-title":"Pediatr. Health Med. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101441","DOI":"10.1016\/j.infbeh.2020.101441","article-title":"Revisiting the roots of attachment: A review of the biological and psychological effects of maternal skin-to-skin contact and carrying of full-term infants","volume":"60","author":"Norholt","year":"2020","journal-title":"Infant Behav. Dev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/JNR.0000000000000194","article-title":"The effects of kangaroo care on the sleep and wake states of preterm infants","volume":"25","author":"Bastani","year":"2017","journal-title":"J. Nurs. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.earlhumdev.2017.12.008","article-title":"Parent participation in the neonatal intensive care unit: Predictors and relationships to neurobehavior and developmental outcomes","volume":"117","author":"Pineda","year":"2018","journal-title":"Early Hum. Dev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e1414","DOI":"10.1542\/peds.2005-2580","article-title":"Reducing premature infants\u2019 length of stay and improving parents\u2019 mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: A randomized, controlled trial","volume":"118","author":"Melnyk","year":"2006","journal-title":"Pediatrics"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Benzies, K.M., Aziz, K., Shah, V., Faris, P., Isaranuwatchai, W., Scotland, J., Larocque, J., Mrklas, K.J., Naugler, C., and Stelfox, H.T. (2020). Effectiveness of Alberta Family Integrated Care on Infant Length of Stay in Level II Neonatal Intensive Care Units: A Cluster Randomized Controlled Trial. BMC Pediatr., 20.","DOI":"10.1186\/s12887-020-02438-6"},{"key":"ref_28","unstructured":"(2025, September 05). University of Witwatersrand: Admissions Registers of Hospital Complex, Prepared by Nursing Services Manager. Available online: https:\/\/www.wits.ac.za\/clinicalmed\/departments\/paediatrics-and-child-health\/hospital-services\/klerksdorp-hospital\/."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.earlhumdev.2006.05.024","article-title":"Mothers\u2019 Perception of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) as Compared to Conventional Care","volume":"83","author":"Kleberg","year":"2007","journal-title":"Early Hum. Dev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1093\/jpepsy\/jsi053","article-title":"Family-based intervention to enhance infant\u2013parent relationships in the neonatal intensive care unit","volume":"30","author":"Browne","year":"2005","journal-title":"J. Pediatr. Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1097\/00006199-199305000-00005","article-title":"Parental Stressor Scale: Neonatal intensive care unit","volume":"42","author":"Miles","year":"1993","journal-title":"Nurs. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.1017\/S1463423619000021","article-title":"Stress and feelings in mothers and fathers in NICU: Identifying risk factors for early interventions","volume":"20","author":"Ionio","year":"2019","journal-title":"Prim. Health Care Res. Dev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"604","DOI":"10.5964\/ejop.v12i4.1093","article-title":"Mothers and fathers in NICU: The impact of preterm birth on parental distress","volume":"12","author":"Ionio","year":"2016","journal-title":"Eur. J. Psychol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e075601","DOI":"10.1136\/bmjopen-2023-075601","article-title":"Randomised trials conducted using cohorts: A scoping review","volume":"14","author":"Nickolls","year":"2024","journal-title":"BMJ Open"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1002\/bdr2.1521","article-title":"The evolution of family-centered care: From supporting parent-delivered interventions to a model of family integrated care","volume":"111","author":"Franck","year":"2019","journal-title":"Birth Defects Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1038\/s41390-019-0385-9","article-title":"Behavioural and cognitive outcomes following an early stress-reduction intervention for very preterm and extremely preterm infants","volume":"86","author":"Milgrom","year":"2019","journal-title":"Pediatr. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"114058","DOI":"10.1016\/j.socscimed.2021.114058","article-title":"Destined for greatness: A Family-based stress management intervention for African-American mothers and their children","volume":"280","author":"Urizar","year":"2021","journal-title":"Soc. Sci. Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Aboud, F.E., Choden, K., Tusiimi, M., G\u00f3mez, R., Hatch, R., Dang, S., Betancourt, T.S., Dyenka, K., Umulisa, G., and Omoeva, C. (2023). A tale of two programs for parents of young children: Independently-conducted case studies of workforce contributions to scale in Bhutan and Rwanda. Children, 10.","DOI":"10.3390\/children10081413"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Kristensen, I.H., Juul, S., and Kronborg, H. (2020). What Are the Effects of Supporting Early Parenting by Newborn Behavioral Observations (NBO)? A Cluster Randomised Trial. BMC Psychol., 8.","DOI":"10.1186\/s40359-020-00467-5"},{"key":"ref_40","first-page":"29","article-title":"Evaluation of stress levels in both parents of newborns hospitalized in the neonatal intens\u0131ve care unit","volume":"8","year":"2023","journal-title":"Mathews J. Pediatr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e20200319","DOI":"10.1590\/0034-7167-2020-0319","article-title":"Characteristics of pregnant women at risk and relationship with type of delivery and complications","volume":"74","author":"Lauretti","year":"2021","journal-title":"Rev. Bras. Enferm."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"538.e1","DOI":"10.1016\/j.ajog.2015.06.064","article-title":"Serious maternal complications after early preterm delivery (24\u201333 weeks\u2019 gestation)","volume":"213","author":"Reddy","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1257\/app.20140262","article-title":"Does grief transfer across generations? Bereavements during pregnancy and child outcomes","volume":"8","author":"Black","year":"2016","journal-title":"Am. Econ. J. Appl. Econ."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ndjomo, G., Njiengwe, E., Moudze, B., Guifo, O., and Blairy, S. (2025). Posttraumatic stress, anxiety, and depression in mothers after preterm delivery and the associated psychological processes. BMC Pregnancy Childbirth, 25.","DOI":"10.1186\/s12884-025-07507-1"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.jogn.2017.02.005","article-title":"Scoping review of the mental health of parents of infants in the NICU","volume":"46","author":"Roque","year":"2017","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.wombi.2015.04.001","article-title":"The assessment of parental stress and support in the neonatal intensive care unit using the Parent Stress Scale\u2014Neonatal Intensive Care Unit","volume":"28","author":"Turner","year":"2015","journal-title":"Women Birth"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/12\/1636\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:43:34Z","timestamp":1764596614000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/12\/1636"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":46,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["children12121636"],"URL":"https:\/\/doi.org\/10.3390\/children12121636","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}