Delivering nurturing care for small and sick newborns in facility-based settings: A scoping review of implementation approaches

Background Early-life nurturing care (NC) interventions are crucial to shape developmental trajectories of small and sick newborns, facing adverse experiences in neonatal care units (NCUs). However, NC implementation remains inconsistent globally. This review catalogued interventions aligned with Nurturing Care Framework (NCF), described implementation strategies, and explored barriers and enablers. Methods Following Joanna Briggs Institute guidance and PRISMA-ScR, we searched four databases (PubMed, Scopus, CINAHL, and Campbell Collaboration) for English-language sources (January 2015 to April 2025). Two reviewers independently screened, selected, and charted data aligned with NCF domains, resolving disagreements with the third reviewer. Findings were synthesized using descriptive mapping and realist-informed context-mechanism-outcome configurations. Results Of 1,125 articles screened, 13 studies were selected (seven from low- and middle-income countries; 10 randomized controlled trials, three observational; five implementation research, one quality improvement). NCF components frequently addressed were safety and security (n=12), responsive caregiving (n=9), adequate nutrition (n=8), and opportunities for early learning (n=8); good health was least addressed (n=1). Interventions like non-pharmacological pain management, environmental modifications, caregiver-led practices and digital training, reduced neonatal stress, improved feeding readiness, and shortened hospital stays. Enablers included leadership commitment, trained staff, and family engagement. Barriers included environmental stressors, fragmented protocols, and staff turnover. Implementation and sustainability were inconsistently reported. Conclusion Evidence on facility-based NC for small and sick newborns is growing but remains fragmented, with limited reporting on strategies, fidelity, and sustainability. Future studies should use implementation science frameworks and prioritize workforce, infrastructure, and policy support to embed NC within NCU protocols. Registration Open Science Framework (OSF) protocol: https://osf.io/aqpyw Reporting PRISMA-ScR checklist and flow diagram are provided in the supplementary materials.