Developmental Observer  •  2020  •  5  

Background

Infants admitted to the Newborn Intensive Care Unit (NICU) 
are at increased risk of developmental delay; additionally, they 
are exposed to sounds but relatively little language. Language 
exposure, such as talking, reading, and singing, is essential for 
speech and language development. Greater language exposure 
and shared reading in the NICU is associated with better neu-
rodevelopmental outcomes.1,2 As such, the American Academy 
of Pediatrics (AAP) recommends that parents begin sharing 
books with infants as soon as possible after birth. Shared book 
reading can help parents promote literacy and reading achieve-
ment in their children; it also enhances parent infant bonding 
and reduces parental stress.3 Intervening in the NICU encour-
ages parents to continue reading to their infant post-discharge; 
however, such a book sharing program has not been carried out 
on a large scale in a heterogeneous and diverse population in the 
Cincinnati region.

Relevance to NIDCAP

This project supports development of relationships between  
parents and infants in a NICU. Such early interactions, 
based upon responsive and synchronous experiences, may 
positively influence infant short-and long-term outcomes. Staff 
involvement that embraces parental partnership builds trust and 
positive unit culture. Embracing the Synactive Theory we know 
that infant behavior proceeds through continuous balancing 
of approach and avoidance behaviors across five subsystems, 
communicated as infant biobehavioral cues. Understanding 
and utilizing these behaviors is key to the length and timing of 
book sharing with infants in the NICU, as we individualize our 
interactions to support the competence of each infant within 
their family’s supportive structure. 

Aim

The aim of this project was to increase the adoption of shared 
book reading between parents and infants by increasing the per-
centage of parents sharing books with their infants in the NICU 
and continuing that book sharing post-discharge.

Method

All families from NICUs in the Cincinnati region from June 1, 
2018 were approached. Discharged families were administered 
an Institutional Review Board (IRB) approved questionnaire at 
their first clinic visit assessing home reading environment and 
shared reading practices, adapted from a validated measure and 
from NICU infant-shared reading literature.3

Results/Findings

Before starting the intervention staff and parent reading 
beliefs and behaviors were assessed, as were the home reading 
environment for infants recently discharged from the NICU. 
The pre-intervention outpatient parent survey clinic in 198 
families showed that 143 (64%) had infants who were never or 
rarely read to in the NICU, while 64 (29%) never or rarely read 
at home. Only 85 (38%) recalled having received anticipatory 
guidance on shared reading in the NICU, and very few (11%) 
recalled being shown how to read to their NICU infant. After 
adjusting for potential confounders, the frequency of reading 
aloud in the NICU was independently associated with the 
frequency post discharge (p<0.001). The NICU Bookworm 
Program was designed with the hypothesis that such a program 
would increase the frequency of book sharing in the NICU and 
at home post discharge. Post intervention our data revealed that 
in 115 families, parents receiving anticipatory guidance increased 
from 38 to 60%. Parents being shown how to share books with 
their infant increased from 11 to 56%. Parents regularly reading 
to their child significantly increased in the NICU (34 to 54%). 
Parents regularly reading to their child at home increased (71 
to 75%), but significant change was seen in the high-risk group 
(parents who did not enjoy reading) from 46% to 72%.

Conclusion

Despite AAP recommendations, there exist significant gaps on 
giving anticipatory guidance to parents in the NICU about 
shared book reading. Healthcare professionals can play a 
significant role in increasing this practice. In our population a 
structured book-sharing program increases reading behaviors 
in the NICU as well as at home post-discharge, with the most 
significant benefit seen in the high risk group of parents who 
themselves do not enjoy reading. 

References:

1. Braid S, Bernstein J. Improved Cognitive Development in Preterm Infants with Shared Book 
Reading. Neonatal Network. 2015,34(1):10-17. 

2. Caskey M, Stephens B, Tucker R, Vohr B. Adult talk in the NICU with preterm infants and 
developmental outcomes. Pediatrics 2014,133(3):e578-584.

3. Lariviere J, Rennick JE. Parent picture-book reading to infants in the neonatal intensive care 
unit as an intervention supporting parent-infant interaction and later book reading. Journal of 
Developmental and Behavioral Pediatrics 2011,32(2):146-152.

Using Newborn Individualized Developmental Care and 
Assessment Program (NIDCAP) Philosophy and Principles in 
the Implementation of a NICU Book Sharing Program
Lacina L, Roux M , Kessler C, Jain V 

Newborn Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
DOI: 10.14434/do.v13i1.29081