Nursing Leadership for Digital NICU Transformation: A Systematic Review of Strategies, Digital Health Integration, and Outcomes in High-Risk Neonates.

BACKGROUND

Digital health technologies are increasingly embedded in Neonatal Intensive Care Units (NICUs), yet the role of nurse-led governance in shaping safe, sustainable implementation for high-risk neonates remains underexplored. This review synthesized evidence on nursing leadership and digital health integration in NICUs.

METHODS

Following PRISMA 2020, six databases were searched (January 2013-January 2025), supplemented by grey literature, reference-list screening, and forward citation tracking. The protocol was prospectively registered with PROSPERO. Eligible empirical studies (n = 18) addressed formal nurse-led governance, operational governance enactment by nurses, or leadership-relevant determinants. Risk of bias was appraised with design-specific tools (Cochrane RoB 2, ROBINS-I, JBI, MMAT); synthesis combined structured narrative and reflexive thematic analysis.

RESULTS

Findings are presented as associations, not causal effects. Favorable signals included a 60% reduction in high-stage device-related pressure injuries in one quality-improvement initiative; 30-day readmission rates of 13.8% among enrolled versus 30.9% among non-enrolled caregivers in a nurse-led post-discharge telehealth intervention; and an approximately 12-day shorter length of stay favoring the intervention in one randomized trial of nurse-led developmental care. Using conservative, author-reported coding, organizational/leadership support (17/18; 94%) and structured training (8/18; 44%) were most frequently documented; funding/IT (22%) and clinical champions (17%) less so. Nurse-led governance could not be statistically separated from co-occurring implementation activities.

CONCLUSION

Across a predominantly observational, low-to-moderate-certainty evidence base, nurse-led governance was consistently associated with stronger implementation processes and selected family- and clinical-level signals when embedded in coordinated training, workflow redesign, and audit-and-feedback. Findings are hypothesis-generating. Comparative-effectiveness and economic evaluations decomposing leadership from co-occurring implementation components are needed.