The effect of tele-nursing on premature infants and their mothers: a systematic review

Abstract

Background

Mothers who have given birth prematurely may need more information and support regarding infant care due to feelings of anxiety or unpreparedness. In this context, counseling, education, and follow-up services for mothers after discharge can be easily provided through tele-nursing applications.

Aim

To determine the effects of tele-nursing interventions on premature infants and their mothers.

Design

A systematic review.

Methods

Studies were included if they were randomized controlled or quasi-experimental trials published in English between 2014–2024 that examined telenursing interventions for premature infants or their mothers; studies using qualitative designs, observational methods, gray literature, or those involving term infants were excluded. PubMed, ScienceDirect, Scopus, Web of Science, Cochrane Library, CINAHL, and MEDLINE databases were searched, yielding a total of 492 studies. The Oxford Centre for Evidence-Based Medicine assessment tool was used to evaluate the quality of evidence. Accordingly, the included studies provided level 1–2 evidence. Due to heterogeneity in outcome measures and study designs, a narrative synthesis approach was used to summarize the findings.

Results

The review included 9 studies, consisting of 5 randomized controlled trials and 4 quasi-experimental studies. Improvements were observed in premature infants or their mothers in 8 of these studies. Tele-nursing was reported to reduce hospital readmissions for premature infants while increasing self-efficacy, attachment, awareness, and hope levels in their mothers. Additionally, a decrease in maternal stress and anxiety levels was among the findings reported in the studies.

Conclusion

Findings from the included studies suggest that, in settings with telenursing services, mothers may have improved access to health support after discharge, which can positively influence maternal and infant outcomes.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-026-04495-1.

Introduction

Preterm infants are defined as live-born babies delivered before the completion of the 37th week of gestation [1]. The World Health Organization reports that approximately 15 million babies are born prematurely each year [2]. The underdevelopment of preterm infants’ bodies increases their risk of experiencing complications during and after birth [3]. These infants are more likely to face learning, vision, and hearing difficulties, and preterm birth is among the leading causes of death in children under the age of 15 [4]. Premature birth, a significant global health issue, also creates a stressful situation for both the baby and the family [3]. Due to their incomplete development, preterm infants require more intensive care and maternal support compared to term infants [5]. Furthermore, preterm newborns separated from their mothers for extended periods and struggling with life-threatening conditions in neonatal intensive care units often experience disrupted growth and development [6]. After preterm birth, parents who are about to embark on a prolonged journey through intensive care with their infants must abandon their expectations of what normal experiences of having a healthy baby entail [7]. The anxiety of being separated from their baby and the feeling of a lack of control over the situation can negatively impact the mental health of parents [8]. Although the discharge of the baby brings excitement and happiness to parents, it can also evoke feelings of anxiety, unpreparedness, and insecurity, which may persist for some time after discharge [9]. Since the mother is the most crucial person in the baby’s support system, she should be encouraged and supported in breastfeeding, expressing milk, and participating in care processes based on the baby’s condition. Moreover, she should be facilitated in the transfer of knowledge regarding the baby’s care both before and after discharge [10].

Studies conducted with mothers of premature newborns have revealed that insufficient knowledge about premature infants, psychological challenges, the necessity of taking full responsibility after discharge, and lack of self-confidence lead to various difficulties for mothers [11, 12]. Additionally, speech, language, and communication difficulties observed in preterm infants and the difficulty mothers face in accessing help to address these issues are also highlighted [13]. Moreover, a systematic review reported that these mothers consistently expressed unmet needs for information and support [7]. To help cope with these challenges, the responsibility of the healthcare team, particularly nurses, guided by the concept of family-centered care, is to build trust with the baby’s mother by creating a space for communication. This helps parents acquire the necessary skills to care for their premature infants after discharge and instills confidence in them [14]. In today’s digital era, advancements in information technology offer new opportunities to overcome the challenges faced by mothers separated from their babies during nursing care. Nurses can utilize social media platforms to share health information digitally, enabling parents to access the knowledge they need anytime, easily [8]. At this point, one of the most critical roles of nurses—providing counseling, discharge education, and follow-up—aims to support parents through telenursing practices [15]. Premature infants require not only medical monitoring but also care, information, and psychosocial support in the post-discharge period. Literature reports that families often lack adequate preparation for discharge, leading to a lack of information and feelings of insecurity regarding home care; this situation highlights the ongoing need for emotional stress, sufficient information, and social support [16]. Furthermore, the lack of standardization in discharge preparation and planning restricts parents’ access to continuous professional support in post-discharge care [17]. These findings underscore the importance of sustainable, accessible, and evidence-based support models for premature infant care.

Telenursing refers to the use of telecommunication technologies to provide health and nursing care to patients and support nursing practices [18]. This approach has the potential to increase access to healthcare, reduce the negative impacts of limited hospital capacity, and decrease the need for face-to-face visits [19]. In the post-discharge care of premature infants, telenursing can strengthen the continuity of home care by offering counseling and educational support to parents and positively impact outcomes such as nutrition, weight gain, and caregiving skills [14, 20]. Furthermore, tele-home care models and telephone-based training programs have been reported to improve maternal and infant outcomes by reducing readmission and stress levels [21, 22]. Therefore, telenursing is seen as a promising care model to meet the increasing support needs of premature infants and their families in the post-discharge period [15].

For instance, a study conducted in Turkey reported that 31.2% of discharged premature infants were readmitted within their first year of life, with the most common causes being lung infections, sepsis, and anemia [23]. Therefore, supporting preterm mothers in providing care to their infants through telenursing is crucial, as it creates an environment where mothers can adequately meet all of their babies’ needs.

In recent years, the number of randomized controlled trials investigating whether telenursing positively impacts premature infants and their mothers during the post-discharge period has increased [24, 25]. However, the evidence regarding its effectiveness remains inconclusive due to methodological variations and heterogeneity across the studies [26]. Consequently, it is crucial for nurses, in particular, to be aware of studies exploring the effects of telenursing on premature infants and their mothers. Therefore, a comprehensive synthesis of high-quality randomized controlled and quasi-experimental studies is urgently needed to provide the highest level of evidence and establish consistent clinical guidelines. This systematic review aims to address this gap in the literature by providing a clear, evidence-based perspective on the effects of telenursing on premature infants and their mothers and contribute to bridging the gap between existing evidence and clinical practice.

The current systematic review specifically focuses on evaluating the impact of telenursing interventions on critical outcomes for both premature infants and their mothers. For infants, the primary outcome is the hospital readmission rate. For mothers, the review investigates psychological and behavioral outcomes, including maternal awareness, hope, self-efficacy, postpartum bonding, stress, anxiety, and breastfeeding practices.

Methods

Aim

This systematic review aimed to examine the impact of telenursing intervention on premature infants and their mothers. For this purpose, the research questions are: (1) What has been identified in the literature regarding the effectiveness of telenursing on premature infants and their mothers? (2) What outcome measures have been reported to explain the effect of telenursing on premature infants and their mothers?

Study design

This study was conducted based The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline [27]. The study protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42023387864.

Search strategy and eligibility criteria

A pilot search was conducted using the inclusion criteria to identify the most relevant keywords for the electronic search. Seven databases (PubMed, ScienceDirect, Scopus, Web of Science, Cochrane Library, CINAHL, MEDLINE) were were thoroughly searched. An initial systematic search of all selected databases was conducted up to August 30, 2024. To ensure completeness and currency of evidence, an updated search was performed on December 17, 2024, using the same databases and search strategy. Due to the limited number of RCTs in the literature, quasi-experimental studies have also been included. In Google Scholar, the keywords “telenursing”, “preterm infants”, “mothers”, and “randomized controlled trial”, and “quasi-experimental studies” were used in different combinations, and the first 30 result pages for each search were screened. In addition, the reference lists of all included articles and relevant reviews were manually searched to identify additional studies. To identify eligible studies, Medical Subject Headings (MeSH) terms were used with the following keywords: (“telenursing” OR “nurse-led telephone support” OR “phone counseling” OR “telephonic”) AND (“preterm” OR “premature infants” OR “preterm births” OR “neonatal” OR “neonatal intensive care unit”) AND (“mothers” OR “maternal” OR “postpartum”) AND (“randomized controlled trial” OR “controlled clinical trial” OR “clinical trial” OR “quasi-experimental studies”). For transparency, an example of a complete search string used in PubMed is provided below:

((“Telenursing”[Mesh] OR telenursing OR “nurse-led telephone support” OR “phone counseling” OR telephonic)

AND

(“Infant, Premature”[Mesh] OR preterm OR “premature infant*” OR “preterm birth*” OR neonatal OR “neonatal intensive care unit”)

AND

(“Mothers”[Mesh] OR mother* OR maternal OR postpartum)

AND

(randomized controlled trial[Publication Type] OR “randomized controlled trial*” OR “controlled clinical trial*” OR “clinical trial* OR “quasi-experimental studies”))

Additionally, the references of selected articles and previous reviews were manually screened. The PICOS framework (Population, Intervention, Comparison, Outcomes, and Study Design) was used to develop the inclusion criteria [28].

Inclusion criteria

Population (P): Premature infants and their mothers, Intervention (I): Telenursing, phone counseling, or nurse-led telephone support. No restrictions were applied regarding the frequency, duration, or type of telenursing interventions., Comparator(s)/Control (C): Studies with control groups that did not receive any intervention, received routine care, or were subjected to comparator interventions were prioritized. However, single-group pretest–posttest (pre/post) quasi-experimental designs were also considered eligible, provided they reported quantitative outcome measures relevant to the research questions. This inclusion was justified by the limited number of high-quality randomized controlled trials in the domain and the real-world feasibility of pre/post designs in evaluating telenursing interventions., Outcome Measurements: Outcomes were not restricted to mean and standard deviation formats. Studies reporting outcomes as medians, interquartile ranges, proportions, percentages, risk ratios, odds ratios, or other appropriate effect measures were also eligible depending on the study design.

In addition, the following conditions were sought for inclusion in the studies:

1. it must have been published in English between 2014–2024 (this date range was selected to ensure recency and methodological comparability, as telehealth/telenursing interventions and technologies have substantially evolved after 2014).

2. it must examine the effects of telenursing on premature babies and their mothers,

3. it must be based on quantitative data analysis.

Exclusion criteria

The exclusion criteria were applied for methodological reasons. Studies published only as abstracts were excluded because they do not provide sufficient methodological or statistical detail for quality appraisal. Qualitative studies and those involving term-born infants were excluded to maintain a homogenous population and outcome framework focused specifically on preterm infants and their mothers. Observational designs, case reports/series, reviews, and protocol papers were excluded because the present review aimed to synthesize evidence from randomized controlled and high quality quasi-experimental studies, which provide the highest level of evidence for intervention effectiveness. Gray literature (such as theses, conference proceedings, and committee reports) was excluded due to the frequent lack of peer review and limited methodological transparency. Studies with low methodological quality were excluded based on prespecified quality assessment criteria to minimize bias in the review findings. Finally, only studies published in English were included due to feasibility constraints and the lack of resources for full-text translation and quality appraisal in multiple languages.

Study selection

The study selection process consisted of three steps: searching for studies, evaluating titles and abstracts, and reviewing full texts. Mendeley Reference Manager version 2.73.0© 2022 (Elsevier, Amsterdam) was used for data management, and duplicate studies were removed. Initially, two independent authors (AMT, SG) searched the databases for relevant studies. The identified studies were then imported into Mendeley, and the suitability of titles and abstracts was assessed. Discrepancies were resolved through consultation with a third researcher (A.Ç). Agreement among the authors was reached following this evaluation process. Studies meeting the inclusion criteria based on their abstracts were recorded in the reference management software, and their full texts were retrieved. The analysis of the studies was conducted independently by two researchers.

Quality assessment

The methodological quality of RCTs was evaluated using the modified Jadad scale. The modified Jadad scale was selected because it is a widely used and validated tool for assessing the methodological quality of randomized controlled trials, particularly with respect to randomization, blinding, and withdrawals. A quality score of ≥4 was considered good, while a score of ≤3 indicated poor quality. This scale assigns a minimum score of 0 for the lowest quality and a maximum score of 8 for the highest quality. In addition, the Cochrane Risk of Bias Tool was used to provide a comprehensive evaluation of potential bias across key domains, in accordance with the Cochrane Handbook for Systematic Reviews of Interventions [29]. For quasi-experimental studies, the JBI Critical Appraisal Checklist for Quasi-Experimental Studies was utilized to evaluate methodological rigor, including clarity of causality, confounding factors, and outcome measurement reliability [30]. This dual-tool approach was used to ensure design-appropriate quality assessment and has been clearly reflected in the Results section and summary tables.

Risk of bias

The Cochrane Modified Risk of Bias Tool was used to assess the risk of bias across six domains as detailed in the Cochrane Handbook for Systematic Reviews of Interventions (Version 5.4.0): selection, performance, detection, attrition, reporting, and other biases. Two authors independently rated the sources of bias as high (−), low (+), or unclear (?) [29]. For quasi-experimental studies, particularly single-group pretest–posttest designs, domains such as random sequence generation and allocation concealment were not applicable, as these designs inherently lack randomization and control groups. Instead, these studies were assessed for risk of confounding, completeness of outcome data, clarity of intervention, and use of valid measurement tools.

Data extraction and synthesis

Initially, a data extraction form was developed based on the study’s objectives and criteria to capture key characteristics, interventions, outcomes, and relevant information. To validate the data extraction form, four studies [15, 25, 31, 32] were randomly selected from the pool of studies. Two researchers (AMT and SG) independently used the form to extract the required data from the selected studies. The extracted data were then compared to identify issues such as lack of clarity, missing information, or confusing sections. Subsequently, a third researcher (AÇ) reviewed the form, revised it where necessary, and addressed identified issues and inconsistencies. After successful completion of pilot tests, the final form was utilized for the main study.

The extracted data, including information on study authors, country, publication year, sample size, inclusion criteria, intervention and control strategies, main outcome variables, and key findings, were documented in a Microsoft Word form. These characteristics of the included studies were then summarized and presented in Table 2. Studies in Table 2 were sorted alphabetically according to the first author’s last name. Additionally, an inter-rater reliability analysis conducted using the SPSS software revealed a kappa value of 0.741, indicating a moderate-to-good level of agreement between the researchers. For calculations involving more than two raters, Fleiss’ kappa coefficient was used. According to Fleiss’ classification, values above 0.75 are considered excellent, values between 0.40 and 0.75 as moderate-to-good, and values below 0.40 as poor agreement [33]. Based on Fleiss’ definition, the value of 0.741 falls within the moderate-to-good range of agreement among raters.

Table 2.

Characteristics of reviewed studies

Study authors (Country)	Sample	Inclusion criteria	Intervention strategies	Control strategies	Time points of assessment	Main variables	Study outcomes	Quality Score/JBI appraisal summary
Akbarian et al. (2017) [34] Iran	Mothers and infants Intervention group (n = 50) or Control group (n = 50)	Prematurity defined as gestational age between the 30th and 36th weeks of pregnancy; - Infant hospitalization in the neonatal intensive care unit (NICU) and childcare department; - Critical illnesses such as intraventricular hemorrhage, intestinal necrosis so on; - The Apgar score below 7 and cardiopulmonary arrest in the birth time and not undergoing mechanical ventilator; - Admission to the hospital for the first time; - Absence of the mother’s physical and mental that makes her inevitably dependent on the care by a third party; - Nulliparous mothers, the ability to speak Farsi, having the ability to take care of the infant.	10 educational topics were taught to them during the first 2 weeks. In the next phone calls, educational materials were reminded and answers were provided to their questions. The duration of phone calls was 10–15 minutes. Lastly, the rate of hospital readmission of the infants 4 weeks, 6 weeks, and 12 weeks after the intervention were assessed by telephone.	Telephone communication to the mothers in the control group was performed for raising their awareness of the causes and rate of hospital readmission in the NICU.	- 4 weeks, six weeks and 12 weeks (at the end of intervention)	- The check list of the causes and readmission rate of premature infants	The rate of hospital readmission in the intervention group 4 weeks, six weeks and 12 weeks after the intervention was significantly lower than the control group.	5
Asghari et al. (2021) [20] Iran	Mothers: Intervention group (n = 50) or Control group (n = 50)	Ability to read and write in Persian, lack of chronic anxiety in the mother (self-reported), the possession of a mobile phone (supporting the Telegram program), the avoidance of infertility treatment methods, the birth of a single baby, hospitalization only due to prematurity (not because of illness).	On the day of discharge, the researcher attended the ward and introduced both herself and the study procedure to the infant’s family and explained the method of working on Telegram to the infant’s mothers for 30 min. It was explained to the mothers that they had to take care of their infants for a month through videos, photos, informative texts, and questions and answers provided in cyberspace and via mobile phones	The control group only received the usual care at discharge	- First day after discharge - The day after the one-month intervention - Four weeks after the end of the intervention	- Parental stress scale	The mean maternal stress level in the intervention group than control group after the intervention had less.	8
Bahmanpour et al. (2023) [14] Iran	Mothers: Intervention group (n = 35) or Control group (n = 35)	The samples consisted of the mothers with premature infants who had recently been discharged from the NICU of Mahdiyeh Hospital affiliated with Shahid Beheshti University of Medical Sciences, who were willing to participate in the study.	The intervention subjects followed the researcher’s account to receive the educational files via mobile phone. Educational materials in the form of text or photos for four weeks and once a day were posted on Instagram by the researcher. The researcher, also provided face-to-face instructions on how to use Instagram to the intervention group subjects, in case it was necessary.	The mothers in the control group received routine treatment and follow-up (visits to the clinic) and did not receive any intervention for four weeks.	- Baseline - Post-retreat - One month (At the end of intervention)	- Hope Scale of Mothers of Premature Neonates Admitted to the Intensive Care Unit - Perceived Maternal Parenting Self-Efficacy Questionnaire (PMPS-Q)	The results showed that telenursing improves hope and perceived self-efficacy in mothers of premature infants after discharge from the NICU.	Include*
Ericson et al. (2018) [31] Sweden	Mothers: Intervention group (n = 231) or Control group (n = 262)	With preterm infants, gestational age < 37 weeks, who had been admitted to one of the NICUs for at least 48 hours and who breastfed or expressed breast milk	The intervention consisted of a daily telephone call to the mother initiated by a member of the BST, that is proactive support, from day one until day 14 after discharge, including weekends. In addition, the mother had the option to call someone in the BST during the same period, that is reactive telephone support.	Control group received standard care.	- Eight weeks after discharge	- Swedish Parenting Stress Questionnaire - Maternal Post-natal Attachment Scale - SF-36	There were no differences between the groups for exclusive breastfeeding, odds ratio nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls.	8
Gholami et al. (2022) [15] Iran	Mothers: Intervention group (n = 144) or Control group (n = 144)	Inclusion criteria were mothers whose infants were premature and hospitalized in one of the NICU’s in selected hospitals only because they were premature (not because of an abnormality or disease in the premature infant)	Mothers in the intervention group were contacted 3–4 days after their infants’ discharge. These phone calls training session lasted 10–20 min and were made every 6 days. Finally, they were contacted 5 times.	The control group only received the ordinary care.	- 24 h prior to the infant’s discharge - One month after discharge	- Infant’s Demographic and Clinical information Form - Awareness Assessment Instrument	The implementation of educational intervention through telenursing reduces the readmission rates in premature infants. In addition, The results showed that in the intervention group, the score of parental awareness of the infant care has increased during the sequential sessions.	Include*
Jafarzadeh et al. (2019) [24] Iran	Mothers: Intervention group (n = 25) or Control group (n = 25)	İnterest and willingness of mothers to participate in the study, the basic reading and writing literacy, nonengagement of parents in medical and paramedical professions, as well as no history of physical and mental problems in mothers based on their medical records, including postpartum depression, anxiety, and addiction. Moreover, other inclusion criteria included no history of traumas and major stressors, such as divorce, the imprisonment of the spouse, the unemployment of spouse or death of a relative during the past years, mothers with a preterm infant with a gestational age of 37–33 weeks.	The intervention group received an educational program designed through telephone and counseling center for the mothers of premature infants that started one week after the admission and continued one week after discharge.	For the control group, only regular care was provided on a daily basis.	- One week after the admission of the infant and then again at the time of discharge.	- Maternal Postnatal Attachment (MPA) - Parent Stressor Scale: Neonatal Intensive Care Unit (PSS-NICU)	The average increase in total attachment scores one week after discharge was significantly higher in the intervention group, compared to that of the control group. Moreover, the average decrease in the total stress score of the intervention group at the time of discharge in comparison to pre-intervention was significantly higher than that of the control group.	Include*
Kongsaenkaew et al. (2024) [32] Thailand	Mothers: Intervention group (n = 21) or Control group (n = 21)	- Aged > 18 years who could communicate and understand Thai; - had no experience caring for a newborn receiving a ventilator; - had a tool for Internet access, such as a tablet, touch screen mobile phone, or computer, and had a LINE application; - had to visit the infant in the NICU more than two times before they were discharged from the postpartum ward.	The 6-day program was developed by the PI based on Bandura’s Self-efficacy Theory and an extensive literature review to enhance maternal perceived self-efficacy of preterm infants with ventilators through a structured sequence of four steps. The PI employed a telehealth approach using the LINE application for message delivery, information sharing electronic books, and video call conferences	Control group received routin care.	- Baseline - Following the intervention period of six days,	- Maternal Self-efficacy Questionnaire	The experimental group had a significantly higher mean score of maternal perceived self-efficacy than the control group, and this was significantly higher than before the trial.	7
Saputri et al. (2024) [8] Indonesia	Mothers Intervention group (n = 16)	Mothers who had LBW babies (birth weight less than 2500 grams) or premature babies (gestational age < 37 weeks) who were treated in the perinatology room of Banyumas Hospital, had smartphones and could operate smartphones, mothers could read and write.	At the first meeting, the baby’s mother took a pretest to measure selfefficacy before being given the Peri-ku application. After that, the baby’s mother was given education using the Peri-ku application. The education process was carried out for 7 days. Monitoring of the education process was carried out twice, then on day 7 a posttest was conducted.	No control group	- At the first meeting - 7 days after the education process	- Perceived maternal parenting selfefficacy (PMP S-E) questionnaire	There is a difference in the average self-efficacy before and after the intervention. Telenursing based on mobile learning is effective in increasing the self-efficacy of mothers of LBW and premature babies	Include*
Tajalli et al.(2020) [25] Iran	Mothers: Intervention group (n = 30) or Control group (n = 30)	All parents of infants admitted to neonatal intensive care units, have access to the telephone and no hearing or speech problems.	In the intervention group, 15 telephonic conversations between parents and nurses were done totally for 15 days. During these phone contacts, the researcher provided information to one of the parents about the neonate’s respiration, recent vital signs, consciousness level, sleeping rhythm, feeding	Control group did not received telenursing intervention.	- Once before the intervention and then after phone calls on the first day and fifth, tenth and fifteenth day	- Beck Anxiety Inventory	- The findings indicated that there was a significant difference in terms of anxiety in the intervention group before and after	8

*Included – see JBI checklist in Supplementary File 2 for full item-level responses

Due to the use of different data collection tools and varying outcome measures in the included studies, statistical pooling of the results and conducting a meta-analysis was not feasible. The findings were narratively summarized under the headings: Scan Results, Study Characteristics, Characteristics of the Interventions, Outcome Measures, Effectiveness of Telenursing Intervention, Study Quality, and Risk of Bias. The study evaluated readmission rates to the hospital for premature infants and health status indicators after discharge; for their mothers, psychological and care-related outcomes such as anxiety, stress, self-efficacy, postpartum bonding, awareness, and hope were assessed.

Results

Scan results

The PRISMA 2020 process was used to illustrate the study selection process and results (see Fig. 1). The search using predefined keywords yielded a total of 492 studies. Of these, 63 studies were excluded due to duplication. During the title and abstract screening of the remaining studies, a total of 419 studies were excluded for the following reasons: irrelevant topic (n = 164), non-compliance with the study population (n = 102), unsuitable study design (n = 59), inappropriate intervention (n = 91), and publication in a language other than English (n = 3). Among the 10 remaining studies, 1 study was excluded as it received a low-quality score (Jadad score ≤ 3) (Randomization and blinding were not defined, and the study’s inclusion criteria were not clearly stated). The full texts of the remaining 9 studies were reviewed for eligibility and quality by three independent researchers.

Fig. 1.

The flow chart (flow diagram) in the selection of the studies

Study characteristics

The studies included in this systematic review employed either randomized controlled trial designs [14, 20, 24, 31, 32] or quasi-experimental designs [8, 15, 25, 34] The populations in the evaluated studies consisted of premature newborns and their mothers. The sample sizes ranged from 16 to 493 participants. The total follow-up durations varied, spanning from one week to 12 weeks post-discharge or post-intervention.

Characteristics of the interventions

In four of the studies, education and counseling services on neonatal care were provided, covering a variety of topics including breastfeeding techniques and nutrition, skin and perineal care, medications, infection control, bathing, infant massage, umbilical cord care, kangaroo care, proper infant positioning, sleep patterns, giving supplement drops, monitoring vital signs and body temperature, infant vaccinations, and awareness regarding care for jaundice, diarrhea, vomiting, and infectious diseases [8, 14, 15, 20, 24, 25, 35]. One study provided an educational program specifically focused on the care activities for ventilated premature infants [32], while another study exclusively delivered telenursing services related to breastfeeding and nutrition [31].

The tele-nursing interventions implemented across the included studies were delivered by registered nurses, neonatal nurses, perinatology nurses, or members of organised breastfeeding support teams, all of whom had clinical expertise in maternal–infant or neonatal care. The mode of delivery varied across telephone calls, mobile learning applications, social media platforms such as Telegram and Instagram, and telehealth systems providing both synchronous video interactions and asynchronous educational content. The frequency and duration of the interventions ranged from short, intensive programs—such as daily calls for 6 to 15 days—to more extended follow-up interventions delivered two to three times weekly over four to twelve weeks, or continuous access to mobile or social media resources over several weeks. Sessions typically lasted 10–20 minutes for telephone-based interventions, whereas app-based and social-media interventions provided ongoing access to instructional materials throughout the intervention period. Overall, these interventions were characterised by continuous, accessible communication and professional support, aimed at increasing maternal confidence, reducing anxiety and stress, and improving caregiving (Table 2). Interventions delivered through telephone calls with two-way interaction, those involving regular and repeated contacts, were more frequently associated with reductions in maternal stress and anxiety and, in some cases, lower readmission rates [15, 24, 25, 34]. In contrast, interventions delivered mainly via mobile applications or social media platforms tended to demonstrate greater improvements in maternal self-efficacy, hope, and knowledge [8, 14, 20, 32]. Programs with higher contact frequency (daily or near-daily) and those extending over several weeks appeared more effective than single or very brief contacts. These observations are based on descriptive comparisons only and should be interpreted cautiously due to heterogeneity across trials.

Outcome measures

In the included studies, the effects of telenursing interventions on premature infants and their mothers were evaluated. The extracted outcomes were synthesized into three primary thematic topics: Maternal Psychosocial Health, Maternal Competence and Behavior, and Neonatal Clinical Results. Table 1 provides a clear overview of these synthesized topics, detailing the specific outcome measures examined under each theme (such as stress, self-efficacy, and hospital readmission rates) and identifying the studies that contributed data to each specific area. This thematic structure guides the presentation of the main findings in the subsequent Results and Discussion sections.

Table 1.

Topics derived from data synthesis and contributing studies

Data Synthesis Topic	Specific Outcome Measure	Consistency of Findings	Supporting Studies
1. Maternal Psychosocial Health	Stress	Consistent positive	3 studies [20, 24, 31]
	Anxiety	Positive (single study)	1 studies [25]
	Hope	Positive (single study)	1 studies [14]
	Awareness	Positive (single study)	1 studies [15]
2. Maternal Competence and Behavior	Self-efficacy	Consistent positive	3 studies [8, 14, 32]
	Postpartum Bonding	Mixed	2 studies [24, 31]
	Breastfeeding Practices	Positive (single study)	1 studies [31]
3. Neonatal Clinical Results	Hospital Readmission Rates	Positive (single study)	1 studies [34]

Effectiveness of telenursing interventions

Across the nine included studies, the effects of telenursing interventions demonstrated overall positive trends, although the consistency of findings varied by outcome domain.

Maternal psychosocial outcomes

Evidence regarding maternal stress and anxiety was largely consistent. All three studies assessing maternal stress reported significant reductions in stress levels among mothers receiving telenursing interventions compared with control groups. Similarly, the single study evaluating maternal anxiety found a statistically significant decrease following the intervention. Morever, Maternal hope and awareness were each evaluated in one study, and both outcomes showed positive effects in favor of telenursing

Maternal competence and behavior

Findings related to maternal self-efficacy were generally consistent, with all three studies reporting significant improvements among mothers who received telenursing support. In contrast, results for postpartum maternal bonding were mixed. Of the two studies examining this outcome, one reported a significant improvement in bonding, while the other found no statistically significant difference between intervention and control groups, although stress levels were lower in the intervention group. Only one study assessed breastfeeding practices, reporting a positive effect of telenursing on breastfeeding outcomes.

Neonatal clinical outcomes

Neonatal hospital readmission rates were evaluated in one study, which reported a significant reduction in readmissions among premature infants whose mothers received telenursing support (Table 2).

Study quality

Of the nine included studies, five were RCTs and were assessed using the modified Jadad scale, yielding scores between 4 and 8, all considered to be of good quality (Supplementary File 1: Quality Table for RCTs). The remaining four quasi-experimental studies were evaluated using the JBI checklist. For each question, responses of Yes/No/Unclear were recorded. These studies demonstrated clear intervention-outcome links, though some lacked control groups and allocation concealment. Detailed item-level quality appraisals for quasi-experimental designs are provided in Supplementary File 2.

Risk of bias

Among the included RCTs, all reported adequate random sequence generation and allocation concealment, indicating low risk of selection bias in these domains. Four RCTs (80% of RCTs) implemented blinding procedures for participants or personnel; however, none reported blinding of outcome assessors, which may increase the risk of detection bias. For quasi-experimental studies, domains such as random sequence generation and allocation concealment were not applicable due to the absence of randomization and, in one case, the lack of a control group. Instead, these studies were evaluated with respect to baseline comparability (where applicable), completeness of outcome data, clarity of intervention procedures, and reliability of outcome measurement. Across all included studies, seven reported no incomplete outcome data, while two studies reported attrition in both intervention and control groups, with reasons clearly described. Therefore, attrition bias was considered low to moderate overall. Additionally, 8 studies (88.9%) reported primary outcomes, indicating low reporting bias. Regarding other biases, 2 studies (22.2%) demonstrated a low risk of bias, while 7 studies (77.8%) showed an unclear risk (Fig. 2, Supplementary File 3: Bias Table).

Fig. 2.

Risk of bias graph

Discussion

This systematic review of Randomized Controlled Trials (RCTs) and quasi-experimental studies offers a critical synthesis of the current evidence on the effectiveness of telenursing for premature infants and their mothers. The findings contribute to addressing an important gap in the literature; however, the available evidence remains limited and heterogeneous. A primary finding of this review is the indication that telenursing interventions may be associated with improved maternal mental health outcomes and reduced neonatal readmission rates, although the strength and consistency of evidence vary across outcomes, suggesting potential implications for clinical practice that should be interpreted cautiously. While the included studies (n = 9) demonstrated considerable heterogeneity in intervention design and duration, the findings provide preliminary evidence suggesting a possible role for the cautious integration of telenursing into post-discharge neonatal care. The subsequent discussion will interpret the potential practical significance of these findings and outline future research directions necessary to standardize and optimize these interventions.

During the postpartum period, parents who expect to hold their healthy baby may experience intense anxiety, stress, or depression due to complications of preterm birth, prolonged neonatal intensive care unit (NICU) stays, and their inability to take an active role in their baby’s care [35]. This review included four studies that examined the effectiveness of telenursing interventions on anxiety (1 study) and stress (3 studies) in mothers of preterm infants. The findings from these studies were generally consistent, showing reductions in mothers’ anxiety and stress levels following the interventions. However, these findings are based on a small number of studies and should therefore be interpreted with caution. Although no previous systematic reviews or meta-analyses have specifically investigated the effectiveness of telenursing interventions in mothers of preterm infants, the literature includes studies on other patient populations that have examined the psychological effects of such interventions. For example, Keshavaraz et al. (2021) [36] found that providing education and counseling through telenursing for one month after discharge significantly reduced depression, anxiety, and stress levels in patients who had experienced myocardial infarction (MI). Similarly, telenursing interventions have been shown to significantly reduce post-discharge stress levels in elderly hemodialysis patients and in patients who underwent coronary artery bypass graft surgery [37, 38]. Telenursing offers nurses an opportunity to help maintain and improve patients’ health based on their self-care needs. It enables nurses to provide services such as monitoring, remote interventions, education, and counseling, along with psychological support during challenging illness periods [39]. The studies included in this review suggest the potential of telenursing interventions to reduce stress and anxiety levels in women who have experienced preterm births.

In three of the studies included in the review, telenursing interventions were found to increase self-efficacy levels in mothers of preterm infants. A mother’s perception of self-efficacy after childbirth affects her ability to care for her baby as well as the baby’s growth and development [14]. Indeed, education and counseling services provided to mothers after the discharge of preterm newborns have been reported to enhance maternal self-efficacy and significantly reduce potential health problems in the baby [5]. A systematic review of randomized controlled and quasi-experimental studies in the literature examined the effects of telenursing interventions on self-efficacy among diabetic patients and found the intervention to be effective in improving self-efficacy levels [40]. Similarly, a study on patients who had experienced myocardial infarction concluded that telenursing should be encouraged, as it yielded positive results in improving patients’ self-efficacy [36]. On the other hand, a study involving patients with schizophrenia found an increase in self-efficacy levels in the intervention group after telenursing; however, the difference compared to the control group was not statistically significant [41]. Telenursing is an intervention based on mutual communication between the patient and the nurse [42]. Taken together, while the broader literature supports a potential role of telenursing in enhancing self-efficacy, evidence specific to mothers of preterm infants remains preliminary and limited in scope.

The studies included in this review yielded mixed results regarding the impact of telenursing interventions on postpartum maternal bonding. Among the two studies analyzed, one found no significant differences between the groups, while the other concluded that the intervention was effective. Anxiety or stress experienced by mothers during the period from the NICU to home care can influence mother-infant bonding. Therefore, providing support to mothers during this period is crucial [24]. A systematic review in the literature examined the effectiveness of early home follow-up interventions for preterm newborns and highlighted that, despite short follow-up durations, such interventions positively affected maternal-infant bonding [43]. In a randomized controlled trial involving mothers who delivered at term and had healthy newborns, telephone follow-ups were conducted within 7–10 days post-discharge. While the mothers’ breastfeeding scores improved, there was no significant change in maternal bonding scores [44]. Another study implemented a telelactation intervention during the third trimester, where nurses provided breastfeeding support. Follow-ups were conducted immediately after birth and three months postpartum for mothers of healthy term newborns. The findings indicated that the intervention improved mother-infant bonding [45]. These findings suggest that intervention characteristics such as duration, intensity, and timing may influence bonding-related outcomes, and highlight the need for further research with standardized designs and longer follow-up periods.

One of the studies included in this review found that telenursing interventions led to a reduction in hospital readmission rates for preterm infants. Providing consistent postpartum care services is crucial for protecting and improving both the physical and mental health of mothers and their infants [46]. Telenursing facilitates mothers’ access to healthcare services and enhances their knowledge through advanced educational opportunities, enabling them to provide better care for their babies [38]. For instance, a study in the literature reported a significant increase in the knowledge levels of mothers with infants diagnosed with esophageal atresia following a telenursing program, emphasizing that this improvement could reduce hospital readmissions [47]. Similarly, another study found that a telenursing intervention program improved postoperative care knowledge among mothers of children who had undergone surgery [48]. Mothers of preterm infants often experience anxiety during the post-discharge period due to their physical distance from healthcare providers. This anxiety is particularly heightened in mothers of infants born before completing intrauterine development, as these infants are at greater risk for health complications [49]. Although reduced readmission rates may plausibly be linked to improved maternal knowledge and access to care, this outcome is currently supported by only one study and therefore requires confirmation in future research.

Despite the promising findings of the included studies, several important research gaps remain. None of the studies evaluated the cost-effectiveness or resource implications of implementing tele-nursing programs, even though such information is essential for guiding clinical and policy decisions. In addition, the existing studies primarily assessed short-term psychological and caregiving outcomes; long-term maternal–infant bonding, sustained maternal self-efficacy, and infant developmental trajectories beyond the early postpartum period remain largely unexplored. Future research should prioritize adequately powered randomized controlled trials with standardized and clearly described intervention protocols, incorporate longer-term follow-up, evaluate cost-effectiveness, and assess longer-term infant health and developmental outcomes to strengthen the evidence base.

Limitations

This systematic review has several limitations. First, the exclusion of articles published in languages other than English may have introduced language bias. Additionally, academic works from the gray literature, such as theses, conference proceedings and committee reports, were excluded, which may have led to the omission of relevant studies. Another limitation is the heterogeneity of outcome measures across the studies, which prevented the synthesis of results through meta-analysis. More importantly, there are a limited number of studies in the literature that include telenursing interventions for premature infants and their mothers, which prevents sufficient comparison with existing research findings. Lastly, while the overall methodological quality of the RCTs was rated as good, some methodological weaknesses were observed, such as small sample sizes and the absence of blinding procedures in certain studies. Future randomized controlled trials involving telenursing interventions for premature infants and their mothers should aim to improve the evidence base by incorporating blinding procedures, larger sample sizes, and longer follow-up durations.

Conclusion

This systematic review highlights the potential positive effects of telenursing interventions on hospital readmission rates for premature newborns and on maternal outcomes such as stress, self-efficacy, anxiety, bonding, awareness, and hope levels. However, the strength of evidence varies across outcomes, with several findings supported by single studies only. These findings are potentially relevant for nursing practice but should be interpreted cautiously given the small and heterogeneous evidence base. Collectively, these findings help to inform a research agenda for the field.

These findings underscore the need for more randomized controlled trials involving telenursing interventions. Moreover, future studies should incorporate long-term follow-up and cost-effectiveness analyses to determine the sustained impact and practical feasibility of telenursing interventions for mothers. Future research should prioritize adequately powered randomized controlled trials with larger sample sizes and standardized, clearly described telenursing intervention protocols to enhance comparability across studies.

Additionally, telenursing, when accessible, may facilitate mothers’ access to health services after hospital discharge and may support maternal and infant health. Importantly, future studies should extend outcome assessment to longer-term infant outcomes, including developmental and health trajectories, to build a stronger and more reliable evidence base.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

PROSPERO

International Prospective Register of Systematic Reviews

PRISMA

Preferred Reporting Items for Systematic reviews and Meta-Analyses

MeSH

Medical Subject Headings

SD

Standard deviations

RCT

Randomized controlled trials

CEBM

Centre for Evidence-Based Medicine

NICU

Neonatal intensive care unit

MI

Myocardial infarction

Author contributions

Seda Göger: Conseption and design, database searching, data extraction, writing – review & editing, resources. Aylin Meşe Tunç: Conseption and design, database searching, writing – review & editing, resources. Ayşe Çevirme: Database search, writing – review & editing, proof reading. All authors reviewed the results and approved the final version of the manuscript.

Funding

Not applicable.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.