Abstract

Background:

Preterm infants face heightened vulnerability during the post-discharge period, particularly concerning feeding challenges, suboptimal weight trajectories, and elevated risks of hospital readmission. Maternal self-efficacy in breastfeeding plays a pivotal role in mitigating these risks, yet many mothers lack consistent, accessible support after leaving the neonatal intensive care unit (NICU). Digital health strategies, including tele-nursing, offer promising avenues to bridge this care gap.

Objective:

This study aimed to assess the impact of an eight-week tele-nursing intervention on maternal breastfeeding confidence, infant weight progression, and hospital readmission rates among mothers of late-preterm infants following NICU discharge.

Methods:

A quasi-experimental design was employed with 60 mother–infant dyads recruited from three tertiary NICUs in Isfahan, Iran, during late 2022. Participants were non-randomly assigned to either an intervention group (n=30), which received structured tele-nursing support via secure domestic messaging platforms (Ita and Soroush), or a control group (n=30) receiving standard post-discharge care. The tele-nursing program included tailored education, real-time problem-solving, and guidance on feeding techniques, infection prevention, and recognition of warning signs. Breastfeeding self-efficacy was measured using the validated 33-item Dennis Short Form scale; infant weight data were obtained from official growth monitoring canters, and readmission events were self-reported and verified.

Results:

Post-intervention, mothers in the tele-nursing group demonstrated significantly higher breastfeeding self-efficacy scores (mean = 154.3) compared to controls (mean = 124.8; p < 0.001). Both groups exhibited expected weight gain over the study period (average increase of ~1,200 g), with no statistically significant intergroup difference (p = 0.45). Notably, zero readmissions occurred in the intervention group, whereas one infant (3.3%) in the control group required rehospitalization due to sepsis.

Conclusion:

Tele-nursing support significantly bolstered maternal confidence in breastfeeding and eliminated early readmissions in this cohort of preterm infants, despite not altering short-term weight outcomes. These findings underscore the potential of digitally mediated nursing interventions to enhance post-discharge continuity of care, empower caregivers, and reduce healthcare utilization—key priorities for neonatal health systems globally.

Keywords:

preterm infants, telehealth, maternal self-efficacy, breastfeeding support, post-discharge care, hospital readmission, digital nursing