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Parental involvement in neonatal decision-making: a narrative review
Yanhui Ma1, Chongyang Zhang1, Ling Lu2
1Department of Neonatology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Frontiers in Pediatrics
|May 6, 2026
Summary
Parents in neonatal intensive care units desire active involvement in decisions, needing clear information and support. Enhancing parental involvement improves understanding and reduces regret, requiring better communication and support systems.
Area of Science:
- Neonatal Intensive Care Unit (NICU) care
- Pediatric decision-making
- Family-centered care
Background:
- Parents in NICUs face complex, time-sensitive decisions amid uncertainty.
- Family-centered care and shared decision-making (SDM) are advocated but poorly understood in neonatal contexts.
Purpose of the Study:
- To synthesize evidence on the variation and contexts of parental involvement in neonatal decision-making.
- To identify factors influencing parental engagement and outcomes.
Main Methods:
- Comprehensive literature search across multiple databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO) up to September 2025.
- Narrative synthesis of empirical studies on parental involvement in neonatal decisions.
- Analysis within a social-ecological framework (individual/family, clinical processes, team/organization, policy/society).
Main Results:
- Parental involvement exists on a continuum from clinician-led to parent-led decision-making.
- Parents desire active participation alongside clear clinical recommendations, timely information, and emotional support.
- Higher perceived involvement correlates with better understanding, values-choice concordance, and reduced decisional conflict/regret.
- Barriers include default pathways, inconsistent information, and inadequate psychosocial support.
Conclusions:
- Optimizing parental involvement requires transparent communication of uncertainty, clear option framing, protected decision windows, and coordinated team communication.
- Interventions should focus on supporting parental agency and reducing decision-making burdens in the NICU.
- Future research should explore tailored strategies to enhance SDM across diverse neonatal contexts.
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