Barriers to Parental Engagement in NICU Infants with Congenital Anomalies: An Exploratory Pilot Study in Fetal Center Mother-Infant Dyads.

Objective This study aimed to explore potential medical, sociodemographic, and maternal mental health (MMH) factors associated with parental engagement in the neonatal intensive care unit (NICU) among mother-infant dyads, followed through a fetal center (FC). Study Design This exploratory pilot study used mixed retrospective and prospective data collection at a Level IV NICU and affiliated FC between June and August 2023. The primary outcome was cumulative parental bedside presence during the first postnatal month. Secondary outcomes included time to first parental visitation, skin-to-skin (STS) care, expressed breast milk (EBM) provision, and MMH indicators. Maternal and infant clinical and sociodemographic variables were retrospectively abstracted from the electronic medical record, while parental visitation patterns were prospectively tracked using bedside documentation tools. Results Sixteen mother-infant dyads were included. Mean time to the first parental visitation was 7.6 h, and mean time to first STS contact was 8.3 days. Exploratory analysis identified patterns suggesting differences in parental engagement by language, insurance status, and MMH indicators. African American parents visited earlier than Caucasian and Hispanic parents ( p = 0.05). Descriptively, English-speaking and privately insured families initiated STS earlier than Spanish-speaking and publicly insured families. Earlier parental visitation was also observed among mothers providing EBM at postnatal day 14 ( p = 0.016). Mothers prescribed psychotropic medications experienced longer delays to first visitation ( p = 0.046). Given the small sample size and exploratory design, findings should be interpreted cautiously. Conclusion In this exploratory pilot cohort of FC mother-infant dyads, parental engagement patterns appeared to vary across sociodemographic and MMH-related factors. These preliminary findings support the feasibility and importance of larger prospective studies examining structural and psychosocial barriers to early parental participation in high-risk NICU populations.