Attachment in the parent-infant dyads is fundamental for growth and development of children born prematurely. However, the natural process of attachment is interrupted just after preterm birth, and emotional and physical detachment, limited social interaction, and a traumatic, technologically heavy environment in a neonatal intensive care unit (NICU) may result in impaired attachment or bonding. To our knowledge, few studies have evaluated the effectiveness of interventions aimed at enhancing attachment, bonding, and relationships between parents and their preterm infants during the infant’s hospitalization in the NICU. This study aims to perform a comprehensive systematic review and a meta-analysis survey of the effects of attachment- and relationship-based interventions in the NICU. A comprehensive literature review will be conducted in the following databases: MEDLINE, CINAHL, PubMed, EMBASE (OVID), Scopus, PsycINFO (OVID), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science. Selected studies will be published in English, in the last 20 years, from 1999 onwards. All studies of randomized controlled trials (e.g., parallel groups, cluster) will be included. We will consider studies evaluating attachment- and relationship-based interventions (e.g., skin-to-skin contact, parental involvement in infant care) versus a comparator (standard of care). The primary outcome will be maternal attachment. Secondary outcomes will include infants’ growth and development, family health, and parenting experience. Data extraction from eligible studies will be conducted independently by two experts who will compare their data. The Cochrane risk of bias tool will be applied to the selected studies. If data permits, we will conduct random effects meta-analysis where appropriate. Subgroup and additional analyses will be conducted to explore the potential sources of heterogeneity considering gender of parents, infants’ sex, and gestational age. Data synthesis will be carried out using the RevMan 5.3 software. Publication bias will be assessed with the graphical funnel plot method and the Egger test. The quality of the evidence will be rated using the methods of the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. The results of this systematic review will discuss the types of attachment- or relationship-based interventions that are effective for facilitating family health outcomes and the babies’ growth and development and will contribute to establishing new evidence in neonatal and family-centered care by providing scientific guidance for clinical practice and further research. PROSPERO CRD42019145834

中文翻译：

---

新生儿重症监护住院期间家庭基于依恋和关系的干预措施：系统评价和荟萃分析的研究方案

父母与婴儿的依恋是早产儿成长和发展的基础。然而，自然的依恋过程在早产后就被打断，情感和身体上的脱离、有限的社交互动以及新生儿重症监护病房 (NICU) 中创伤性的、技术繁重的环境可能会导致依恋或联系受损。据我们所知，很少有研究评估旨在增强婴儿在新生儿重症监护病房住院期间父母与其早产儿之间的依恋、联系和关系的干预措施的有效性。本研究旨在对 NICU 中基于依恋和关系的干预措施的效果进行全面的系统回顾和荟萃分析调查。将在以下数据库中进行全面的文献综述：MEDLINE、CINAHL、PubMed、EMBASE (OVID)、Scopus、PsycINFO (OVID)、Cochrane 系统评价数据库、Cochrane 对照试验中央注册库 (CENTRAL) 和 Web of Science 。从 1999 年起，过去 20 年的选定研究将以英文出版。所有随机对照试验（例如平行组、集群）的研究都将包括在内。我们将考虑评估基于依恋和关系的干预措施（例如，皮肤接触、父母参与婴儿护理）与比较器（护理标准）的研究。主要结果将是母性依恋。次要结果包括婴儿的成长和发育、家庭健康和养育经历。合格研究的数据提取将由两名专家独立进行，他们将比较他们的数据。Cochrane 偏倚风险工具将应用于选定的研究。如果数据允许，我们将在适当的情况下进行随机效应荟萃分析。将进行亚组和额外分析，以探讨考虑父母性别、婴儿性别和胎龄的潜在异质性来源。数据合成将使用RevMan 5.3软件进行。发表偏倚将通过图形漏斗图方法和 Egger 检验进行评估。将使用推荐等级评估、制定和评估 (GRADE) 工作组的方法对证据的质量进行评级。本系统评价的结果将讨论基于依恋或关系的干预措施的类型，这些干预措施可有效促进家庭健康结果和婴儿的成长和发育，并将通过提供科学的指导，有助于在新生儿和以家庭为中心的护理方面建立新的证据。为临床实践和进一步研究提供指导。普洛斯彼罗 CRD42019145834