• Justine Dol, Alannah Delahunty-Pike, Sheren Anwar Siani, and Marsha Campbell-Yeo.
• Department of Health, Faculty of Health, Dalhousie University, Halifax, Canada.
• JBI Database System Rev Implement Rep. 2017 Dec 1; 15 (12): 2981-3005.

BackgroundAs technology becomes increasingly more advanced, particularly video technology and interactive learning platforms, some neonatal intensive care units are embracing electronic health (eHealth) technologies to enhance and expand their family-centered care environments. Despite the emergence of eHealth, there has been a lack of systematic evaluation of its effectiveness thus far.ObjectivesTo examine the effect of eHealth interventions used in neonatal intensive care units on parent-related and infant outcomes.Inclusion Criteria Types Of ParticipantsThis review considered studies that included parents or primary caregivers of infants requiring care in a neonatal intensive care unit.Types Of Intervention(S)This review considered studies that evaluated any eHealth interventions in neonatal intensive care units, including education (e.g. web-based platforms, mobile applications); communication (e.g. videos, SMS or text messaging), or a combination of both. Comparators included no eHealth interventions and/or standard care.Types Of StudiesExperimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, and analytical cross sectional studies were considered.OutcomesThis review considered studies that included parent-related outcomes (use and acceptance, stress/anxiety, confidence, financial impact, satisfaction and technical issues) and neonatal outcomes (length of stay, postmenstrual age at discharge, parental presence and visits).Search StrategyA systematic search was undertaken across four databases to retrieve published studies in English from inception to November 18, 2016.Methodological QualityCritical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI).Data ExtractionQuantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI-SUMARI.Data SynthesisA comprehensive meta-analysis for all outcomes was not possible and data has been reported narratively for all outcomes.ResultsEight studies met inclusion criteria and were included in the review. The majority of the studies were low to very low quality. The study design and type of eHealth technology examined varied greatly. There appears to be growing interest in the topic as over half of the included studies were published within the past two years. Primary findings suggest parent acceptance and use of eHealth interventions but an unclear impact on neonatal outcomes, particularly on length of stay, a commonly reported neonatal outcome. Due to the variation in eHealth interventions, and heterogeneity across studies, meta-analysis was not possible. Numerous single studies and small sample sizes limited the degree of adequate strength to determine statistical differences across outcomes.ConclusionsWhile heterogeneity across studies precluded meta-analysis, consistent trends across all studies examining parental acceptance of eHealth interventions indicate that parents are willing to accept eHealth interventions as part of their neonatal intensive care, suggesting that the incorporation and evaluation of eHealth interventions in the neonatal intensive care unit setting is warranted. Further high quality studies are needed with larger sample sizes to detect changes in outcomes. As eHealth intervention studies move beyond feasibility and implementation, there is a demand for randomized control trials to examine the effect of eHealth interventions on parent and neonatal outcomes compared to usual care. Future studies should consider reporting of outcomes using standardized measures which would allow comparison across eHealth interventions in subsequent reviews.

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