Supplementary Material for: A Pilot Randomized Controlled Trial of 24-h Webcam Access in the Neonatal Intensive Care Unit

Introduction: Although interest is increasing, 24-h live-streaming webcams are rare in neonatal intensive care units (NICUs), underscoring the need for evidence to support their use. Therefore, we evaluated the effect of 24-h webcam access on parental anxiety, bonding, and postpartum depression in a NICU setting and examined the impact on the workflows of healthcare providers.
Methods: This study was conducted from April 2023 to March 2024 in a tertiary NICU in Japan, as a pilot randomized controlled trial designed to assess feasibility and estimate the potential effect size. Parents of infants expected to stay >1 month in the NICU were enrolled. Participants were randomized to receive 24-h webcam access or no webcam access (control). The primary outcome was the Mother-to-Infant Bonding Scale (MIBS) score at 1 month after birth. Secondary outcomes included the State-Trait Anxiety Inventory (STAI), Edinburgh Postnatal Depression Scale, salivary oxytocin levels, breastfeeding volume, and staff perceptions assessed birth and at 1 month.
Results: Eighty parents of 41 infants were enrolled. MIBS scores did not differ significantly between groups (mothers: 2.4±2.1 vs 2.3±1.8; fathers: 3.4±2.8 vs 4.2±2.1). In contrast, STAI scores decreased significantly in the webcam group at 1 month (mothers: 48.0 to 37.3; fathers: 44.3 to 35.6; both p<0.001), with a significant between-group difference (p<0.05, difference-in-differences analysis). Staff surveys indicated that 92% of nurses supported webcam use, and no adverse events occured.
Conclusion: Continuous 24-h webcam access reduced parental anxiety and was well accepted by staff and families. Larger multicenter studies are warranted to validate our findings.