Impact of Picture Book Reading on Preterm Infant Stability, Parental Anxiety, and Parent-Child Attachment

The Effectiveness of Parental Reading Picture-book Intervention on Cardiopulmonary Stability, Hospitalization Anxiety and Parent-Child Attachment Relationship With Premature Infants

This study investigates the effects of a parent-child picture book reading intervention on the cardiopulmonary stability of preterm infants, parental anxiety, and parent-child attachment. A randomized controlled trial will be conducted in a neonatal intensive care unit (NICU) and neonatal intermediate care unit in northern Taiwan. A total of 88 preterm infants and their parents will be randomly assigned to an intervention or control group. Parents in the intervention group will read picture books to their infants from a corrected gestational age of 28 weeks to 36 weeks and 6 days. Physiological data (heart rate, respiratory rate, oxygen saturation, and heart rate variability) and parental anxiety levels will be assessed at multiple time points. The study aims to determine whether this intervention improves infant stability, reduces parental anxiety, and enhances parent-child attachment, contributing to improved neonatal care practices.

Study Overview

• Status: Recruiting
• Conditions: Effects of Parent-Child Reading on Preterm Infant Stability, Parental Anxiety, and Parent-Child Attachment
• Intervention / Treatment: Behavioral: Parental Reading Picture-book

Detailed Description

Background The birth and survival rates of preterm infants in our country have significantly improved. However, due to the immaturity of their autonomic nervous systems, preterm infants are at risk of complications stemming from unstable vital signs. This instability often induces anxiety in parents, which can further impact their psychological adjustment and hinder the establishment of a secure parent-child attachment. Consequently, this study aims to develop a systematic intervention program using picture book reading to improve the cardiopulmonary stability of preterm infants, alleviate parental anxiety, and enhance the parent-child bond.

Objective To evaluate the effects of a parent-child picture book reading intervention on the cardiopulmonary stability of preterm infants, parental anxiety during hospitalization, and the parent-child attachment relationship.

Methods This study will employ a randomized controlled trial (RCT) design. Participants will include preterm infants and at least one parent from the neonatal intensive care unit (NICU) and neonatal intermediate care unit of a medical center in northern Taiwan. A total of 88 pairs of preterm infants and their parents will be recruited and randomly assigned to either the experimental or control group. The intervention consists of parents reading picture books to their preterm infants, starting at a corrected gestational age of 28 weeks and continuing until 36 weeks and 6 days. Data will be collected at multiple time points, including measurements of heart rate, respiratory rate, oxygen saturation, and heart rate variability. Subjective data will be gathered using the State-Trait Anxiety Inventory (STAI) and the Parent-Child Attachment Scale, while objective data will be recorded via physiological monitors and heart rate variability analyzers. Statistical analyses, including independent samples t-tests, repeated measures ANOVA, and generalized estimating equations (GEE), will be performed to compare the intervention's effectiveness.

Project Goal To develop and evaluate the effectiveness of a parent-child picture book reading intervention program for preterm infants. The findings aim to inform pediatric clinical care practices and support the health and well-being of families with preterm infants.

• Study Type: Interventional
• Enrollment (Estimated): 88
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: CHI-WEN CHEN, PhD; Phone Number: 02-28267348 +886989581661; Email: chiwenchen@nycu.edu.tw
• Study Contact Backup: Name: PEI-YU LO; Phone Number: +886-2-28757083; Email: pylo2@vghtpe.gov.tw

Study Locations

• Taiwan
  • Beitou
    • Taipei, Beitou, Taiwan, 112
      • Recruiting
      • Taipei Veterans General Hospital
      • Contact: PEI-YU LO; Phone Number: +886 2-2875-7083; Email: pylo2@vghtpe.gov.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Preterm Infants:

  1. Born between 28+0 and 36+6 weeks of gestation.
  2. Transferred out of the incubator as per medical advice.
  3. Passed the newborn hearing screening in both ears.

• Parents of Preterm Infants:

  1. Able to read and comprehend Chinese-language materials.
  2. Capable of communicating in Mandarin.

Exclusion Criteria:

• Preterm Infants:

  1. Presence of external ear abnormalities.
  2. Receiving sedatives, hypnotics, or caffeine therapy.

• Parents of Preterm Infants:

  1. Having auditory or speech impairments.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Routine Care; The control group in this study will receive standard routine care in the neonatal ward and intensive care unit of a medical center in Northern Taiwan. Routine clinical care involves one parent visiting the preterm infant during visiting hours. After the physician or nurse explains the infant's current condition to the parent, the parent is allowed to visit the preterm infant freely for half an hour. On the day of discharge, control group participants will receive the same educational booklet titled "Reading Picture Books from Scratch" as the experimental group. The benefits and importance of picture book reading interventions will be explained to them, and parents will be encouraged to use the gifted picture books for reading activities at home.
Experimental: Preterm Infant Stability, Parental Anxiety, Parent-Child Attachment	Behavioral: Parental Reading Picture-book; In addition to receiving routine care, the experimental group will be given the "Reading Picture Books from Scratch" educational booklet once the preterm infant is removed from the incubator, the group assignment is confirmed, and participation in the study is verified. They will then undergo the "Picture Book Reading Intervention." This intervention targets the preterm infant and one of the parents. It involves reading picture books from the second to the fourth day after the infant is removed from the incubator, during the visiting period from 14:10 to 14:20.; Other Names: Experimental Group

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cardiopulmonary stability	The intervention period in this study begins on the second day after the preterm infant is transferred out of the incubator and concludes on the fifth day. Data collection occurs at 24 time points throughout the study. Physiological indicators, including heart rate, respiratory rate, oxygen saturation, and heart rate variability, are recorded at 14:00, 14:10, and 14:20 on the second to fourth days after incubator transfer, as well as at 14:20 on the fifth day.	ecorded at 14:00, 14:10, and 14:20 on the second to fourth days after incubator transfer, as well as at 14:20 on the fifth day.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospitalization anxiety	After group assignment is confirmed, the parents of the participants complete the pretest questionnaire of the State-Trait Anxiety Inventory (STAI). On the fifth day of the study, they complete the posttest questionnaire of the State Anxiety Scale. The STAI consists of 20 items, scored using a 4-point Likert scale: 1 ("Not at all"), 2 ("Somewhat"), 3 ("Moderately so"), and 4 ("Very much so"). The total score is the sum of all item scores, with higher scores indicating higher levels of anxiety. A total score of 20-39 indicates mild anxiety, 40-59 indicates moderate anxiety, and 60 or above indicates severe anxiety.	After confirming the assigned group, and research Day 5
parent-to-infant attachment	After group assignment is confirmed, the parents of the participants complete the pretest questionnaire of the "Maternal Attachment Inventory". On the fifth day of the study, they complete the posttest questionnaire of the "Maternal Attachment Inventory(MAI)". The MAI consists of 22 items, scored using a 4-point scale ranging from 1 ("Almost never") to 4 ("Almost always"). The total score ranges from 22 to 88, with higher scores indicating a stronger mother-infant attachment.	After group assignment is confirmed ,and the fifth day of the study.

Collaborators and Investigators

• Sponsor: National Yang Ming Chiao Tung University
• Collaborators: Taipei Veterans General Hospital, Taiwan
• Investigators: Study Chair: Mei-Jy Jeng, PhD, Taipei Veterans General Hospital, Taipei

Study record dates

Study Major Dates

• Study Start (Actual): June 23, 2025
• Primary Completion (Estimated): June 28, 2026
• Study Completion (Estimated): June 28, 2026

Study Registration Dates

• First Submitted: February 25, 2025
• First Submitted That Met QC Criteria: February 25, 2025
• First Posted (Actual): March 3, 2025

Study Record Updates

• Last Update Posted (Estimated): September 30, 2025
• Last Update Submitted That Met QC Criteria: September 24, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Keywords: Premature Infants; Reading Picture-book; Hospitalization anxiety; Cardiopulmonary stability; parent-child attachment relationship
• Additional Relevant MeSH Terms: Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Obstetric Labor, Premature; Obstetric Labor Complications; Pregnancy Complications; Premature Birth
• Other Study ID Numbers: 2025-02-002A

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No