Feasibility and Impact of a Pilot Neonatal Cuddler Program on Preterm Infants in the Neonatal Intensive Care Unit

Kylie Bushroe, Brieann Lloyd, Chonita McDaneld, Amit Mathur, Rakesh Rao

Research output: Contribution to journalArticlepeer-review


Objective Preterm infants experience daily stress in the neonatal intensive care unit (NICU). Positive sensory experiences mitigate stress responses, but parental participation can be limited by external pressures. This study aimed to describe the impact of a neonatal cuddler program (NCP) on preterm infants' growth. Study Design A multidisciplinary program trained volunteers to interact with NICU infants when family was not at bedside. Infants were followed prospectively throughout admission. Intervention data included frequency, type, and duration of activity throughout the study period. Student t -test and chi-square test were used to analyze the impact of volunteer interaction on anthropometric measures at discharge. Results Forty-five infants interacted with a volunteer (intervention group, n = 45) compared with the control group (n = 56) following coronavirus disease 2019 restrictions. The median (range) time of interaction with a volunteer in the intervention group was 90.0 (5.0-705.0) minutes per infant. Infants in the two groups had similar gestational ages, birth weights, lengths, and occipitofrontal circumferences (OFC). Infants in the intervention group had higher rates of spontaneous intestinal perforation, bronchopulmonary dysplasia, and reached full enteral feeds later. However, rates of severe intraventricular hemorrhage, retinopathy of prematurity, and duration of mechanical ventilation were similar. Infants in the two groups did not differ in the NICU length of stay. At discharge, infants in the intervention group weighed more (p = 0.04) and had higher OFC's (p = 0.01) and OFC z -scores (p = 0.03). The change in z -scores from birth to discharge was significant for the weight (p = 0.02) but not length or OFC. In regression analyses, only group allocation was identified as a significant factor for OFC z -scores at discharge (β = 0.279, p = 0.011) and for change in weight z -scores from birth to discharge (β = 0.226, p = 0.041). Conclusion Growth is positively impacted by an NCP despite limited interaction. Additional work is needed to demonstrate the impact on neurobehavioral and developmental outcomes. Key Points Establishing and implementing a neonatal cuddler program in a large, level IV NICU is feasible. Neonatal cuddler programs can provide positive sensory experiences when parents are not at bedside. Even limited exposure to these positive sensory experiences can positively impact growth parameters for preterm infants.

Original languageEnglish
JournalAmerican journal of perinatology
StateAccepted/In press - 2022


  • anthropometric measures
  • neonatal cuddler program
  • positive sensory experiences
  • preterm infants


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