Trend analysis of family-centered care in the neonatal intensive care unit(NICU): a bibliometric study

Authors

Abstract

AimThe study focuses on the analysed trends in FCC practices in NICUs and their effects on neonatal and family outcomes.
MethodsThis study conducted a bibliometric analysis of 1,198 peer-reviewed articles from the Scopus database (2000–2025). Publication, citation, H index, and keyword analysis were used to track research developments. Research themes were identified using co-citation analysis and bibliometric mapping (VOSViewer) tools to identify intellectual connections and institutional contributions.
ResultsThe number of publications by FCC in NICUs (2000–2025) was analysed, and 1,198 publications were found, with the U.S. (2,208), Canada (555), and the UK (250) in corresponding order. With 28 articles, Axelín A is the leading author, and the University of Turku is the leading affiliation (Affiliation with 64 publications). Female (1,163) and infant (799) are the most frequent keywords. From 95 articles, Advances in Neonatal Care emerges as the leading source of information.
ConclusionThe results of this study reiterate the growing importance of Family Centered Care (FCC) in NICUs, key contributors, institutions, and journals. FCC improves neonatal outcomes and family well-being while recognizing the need for global collaboration.

Keywords

Introduction

Family-centered care (FCC) is the healthcare approach that acknowledges the family’s role in a patient’s normal well-being and recovery, particularly in the neonatal intensive care unit (NICU).¹ FCC principles respect families’ unique needs and culture, empower them to participate in care decisions, and promote open communication.² FCC units in NICUs achieve priority rank and focus predominantly on creating a healing environment, which is accomplished by offering private spaces and educating parents.³
Before the FCC, medical care of children was largely limited to clinical interventions with less consideration of the child’s psychological and emotional needs or the child’s family. The care process often excluded families, leaving families feeling helpless and disconnected from the child’s well-being. FCC grew to include skin-to-skin contact (kangaroo care), shared rounding, and family-led care plans.⁴
The Neonatal Intensive Care Unit (NICU) is a specialized hospital unit in which premature newborns, low birth weight, or critically ill newborns are cared for and closely monitored by intensive care.⁵ These are units of a controlled environment with life-sustaining technology, stabilizing fragile infants in their most critical weeks or months of life. NICU cares for different conditions, including respiratory distress syndrome, congenital anomalies, infection, and complications of prematurity.⁶
Family-centered care (FCC) significantly improves infant outcomes by promoting a nurturing environment that enhances infants’ physical and emotional well-being.⁷ Strong parent–infant bonding early and sustained helps parents regulate emotions and helps with cognitive growth.⁸ Implementation of family-centered care (FCC) in NICUs is a very challenging process. One of the main obstacles is time constraints since NICU staff often work with highly critical sick newborns at a fast pace.⁹ Another barrier is staff resistance, which is based on the staff’s fear that doing something with families might prevent the family from fully engaging with the clinical workflows or delay critical procedures.¹⁰
The objectives of the study are to identify key developments in the implementation of FCC, evaluate the benefits of FCC to infants and families, identify barriers to the adoption of FCC, and explore institutional and cultural factors that influence the use of FCC to improve FCC practices and inform public policy relating to NICU care.

Materials and Methods

Data Resource and Search Strategy
The study was performed using data gathered in the Scopus database, a leading database renowned for its wide and high-quality academic content. The study covers the timespan from 2000 to 2025, a 25-year period covered to track the evolution of FCC practices and obtain a long-term view of research developments in the field. The dataset consisted of 1,198 peer-reviewed journal publications, ensuring credibility and relevance.
Analysis of this subject revealed a total of 326 unique sources, including journals and books, of which only 232 were published. Most relevant studies were extracted using search terms “family-centered care”, “neonatal intensive care”, “parental involvement”, and “neonatal outcomes”. Advanced bibliometric data from Scopus, such as Keywords Plus (3,445) and Author’s Keywords (2,197), allowed for the analysis of recurring concepts and emerging trends.
This research strategy directed the choice of articles based on the systematic selection of influential and thematically relevant publications to obtain a comprehensive and insightful view of FCC trends in the NICU. Key metrics extracted included the number of publications, authors, citations, and publication years. Contributions’ impact and academic influence, along with associated institutions, were evaluated using author affiliations and H-index. In addition, references to other countries and regions were included to evaluate FCC research globally. Journals were categorized, and research focus areas were identified through keyword analysis, including Keywords Plus and Author’s Keywords.
Ethical Approval
Since there were no human or animal participants in our study and the study used publicly accessible resources, ethics committee approval was not obtained. No personal information was provided in this paper.
Bibliometric Analysis
Bibliometric indicators are major in quantifying research trends and academic impact.¹¹ The volume and influence of research from 2000 to 2025 were assessed using metrics such as the number of publications (NP) and citations (NC). The sample consisted of 1,198 articles with an average citation rate, indicating intensive academic attention.
The study was mapped with the help of co-citation analysis, which examined the frequency at which two articles were cited together to study intellectual connections and foundational literature. Further, keyword co-occurrence analysis identified core themes and research hotspots based on data created using Keywords Plus and 2,197 Author’s Keywords.

Results

Overview of Publications on FCC
The study presents an overview of publications related to FCC in NICU over a 25-year period (2000–2025). A total of 1,198 journal articles were analyzed, showing a strong focus on FCC among the academic and clinical research community. Collaborative authorship was evident, with an average of 4.99 co-authors per document, indicating interdisciplinary participation. Articles with international co-authorships constituted about 15.44% of the total, reflecting global significance.
Annual Trends of Publication Quantity
The analysis of annual publication trends on FCC in NICUs shows steady increases over the years, with large growth in the last decade (Figure 1).
Contributions of Countries
FCC research and implementation are dominated by the United States, which also leads with 8,992 citations. Other influential contributors include Canada (2,335) and Sweden (1,223), both well cited and ranked among the top 2,000 most cited authors (Figure 1). Global contributions also came from Australia (1,059) and the United Kingdom (822). Countries such as Israel (427) and Portugal (296) showed high citation averages despite producing fewer publications (Figure 1).
Countries’ Production Over Time
The United States demonstrated strong growth, increasing from 24 articles in 2000 to 2,208 in 2025. Canada and the UK also showed steady increases, reaching 555 and 250 articles, respectively (Figure 1C). Most corresponding authors were from the U.S., with 412 articles—93.7% being single-country publications (SCP) and 6.3% multi-country (MCP).
Analysis of Affiliations
Leading academic institutions contributed significantly to FCC research. The University of Turku led with 64 articles, followed by the University of Toronto (58). The University of California (UC) and the University of Calgary also made sustained contributions, with 56 and 50 articles, respectively (Figure 2).
Performance of Authors
Axelín A led with 28 articles, highlighting significant contributions to the field. Lehtonen L (24 articles), Franck LS (19), and Latour JM (16) were also key contributors (Figure 2). According to Lotka’s Law, scientific productivity is inversely proportional to the square of the number of authors.¹² The H-index was used to reflect researchers’ impact, representing the number of publications (H) that have each been cited at least H times.¹³
Analysis of Journals
With over 95 publications, *Advances in Neonatal Care* stood out as a key journal for high-impact research and innovation in neonatal care, especially in the past decade (Figure 3). According to Bradford’s Law, a small core of journals holds most of the field’s literature. *Advances in Neonatal Care* was identified as a core source in neonatal research.¹⁴
Research Keywords Analysis
Frequently used terms such as “female” (1,163), “male” (845), “human” (998), and “humans” (839) reflected a strong focus on gender and human-centered care in neonatal research. By 2024, “female” emerged as the most common term, likely linked to maternal roles, followed by “human,” emphasizing person-centered approaches.
Between 2001 and 2010, terms like “neonatal intensive care unit,” “infant,” and “newborn” dominated, indicating foundational research. After 2010, focus shifted toward “family nursing,” “parent,” and “child care,” with significant growth by 2015, reflecting the rise of family-centered practices.
In the last decade, themes such as “psychological aspects,” “social support,” and “parent–infant bonding” gained attention, showing increasing interest in emotional and relational factors. Clinical terms like “oxygen saturation” and “infection control” underlined evidence-based care, while the rise of “nursing methodology research” and “adaptive behaviour” since 2015 reflected growing methodological innovation.
By 2023, terms like “infant,” “NICU,” and “family-centered care” were highly frequent, while emerging themes such as “social determinants of health” and “health promotion” suggested a shift toward holistic and professional practices in neonatal care.

Discussion

FCC is a critical approach to healthcare for the neonate in which family involvement in neonatal care improves outcomes for infants and families. The research has been conducted using Scopus, a widely recognised academic database, where 1,198 peer-reviewed articles were analysed, focused on key developments during 25 years. Keywords Plus (3,445 terms) and Author’s Keywords (2,197 terms) are used to identify recurring themes in the analysis of 326 unique sources, including 232 published works. Scholarly impact and contributions to global research are shown by global metrics like publication count, citations, and H index. The findings suggest that family-centered care (FCC) is of increasing importance in NICUs as neonatal outcomes and family wellbeing continue to be promoted. Kokorelias et al.¹⁵ emphasised that the steady rise in publications reflects the global push to incorporate patient and family-centered approaches into healthcare.
The rapid increase in publication numbers after 2010 may reflect increased attention to the FCC’s contribution to neonatal survival rates and less parental stress. Interdisciplinary research has been facilitated by the trend of collaborative authorship, whereby medical, psychological, and nursing perspectives of FCC research have become integrated.¹⁶ This recognition of the FCC as a priority is highlighted by its global significance as a component of international co-authorship.
Study findings illustrate the worldwide distribution of FCC research in NICUs with strong contributions from the United States, Canada, and many European countries. The research output and citations are led substantially by the United States, due to its extensive healthcare infrastructure and adoption of evidence-based practices. However, that leadership is evidenced by Franck et al.¹⁷ which demonstrates the critical role that the FCC plays in improving neonatal outcomes. Examples of countries with consistent growth are Canada, Australia, and the United Kingdom, which positively emphasize core neonatal collaborative endeavours. Although MCP percentages, along with high DMP fulfilment and data sharing rates, are also observed in European countries such as Italy, Finland, and Denmark, which resonate with European Union research frameworks that emphasise international partnerships. China, India, and Iran’s emerging contributions to the FCC happily highlight its global importance. In particular, studies performed by Sigurdson et al.¹⁸ highlight the critical importance of further expanding the FCC research in a way that can mitigate disparities and ultimately improve neonatal care in underserved areas.
The discussion underlines that academic institutions have the central responsibility to guide the development of research efforts in FCC for NICUs. University of Turku publishes 64 papers and can be recognised as the leader in FCC research, while constantly active in this field since 2017. Research like Weber et al.¹⁹ established an important position in supporting FCC practices that include parents’ engagement as well as neonatal well-being. Likewise, over 58 publications produced since 2013 are indicative of the University of Toronto’s commitment to growth and focus on research. However, McManus’s.²⁰ study explains the contribution of the FCC in enhancing emotional support. Both the University of California and the University of Calgary maintain a progressive upward trend in output, which is suggestive of a purposive effort towards enhancing FCC research. Research by Vasli.²¹ encourages regional and international collaboration, following research based on FCC’s cultural adaptation in various places. They also show that the promotion of FCC mattresses is part of the global academic efforts aimed at the development of FCC knowledge.
Author productivity in FCC research aligns with Lotka’s Law, where a few prolific authors contribute significantly. Axelín A leads with 28 articles, followed by Lehtonen L with 24 and an H-index of 17, indicating both quantity and quality. Most authors have only one publication, while a few, like Feeley N and Latour JM, show high impact with moderate output. This concentrated pattern mirrors other specialized fields, highlighting the value of both prolific and occasional contributors for advancing and diversifying FCC research.^22,23
The findings also demonstrate that key authors in FCC research are both productive and influential throughout time, a mix of prolific and steady researchers. Axelín A and Lehtonen L have grown to a great extent publications representing leaders in the field. Contributions by authors Franck LS and Latour JM contribute to keeping steady in spite of time and leave us with the sense that the contributions remain sustained at this commitment level to keep advancing FCC knowledge. However, Chen et al.²⁴ study analysed how high-impact and cooperative authors contribute to nurturing innovation and keep up research growth in particular narrow subject areas. The findings emphasize the central role of core journals in the field of family-centered neonatal care research outlined by Bradford’s Law. Their H-index shows high productivity and impact, and the field is driven by leading journals such as Advances in Neonatal Care, which pump out high output and influence. This is consistent with Scher’s.²⁵ finding, where a small set of key journals dominate in determining the area in which the academics work. The Journal of Neonatal Nursing and Journal of Perinatal and Neonatal Nursing have provided consistently as foundational resources in the care of the neonatal child, advancing clinical and interdisciplinary advancements.

Limitations

This study has several limitations. First, relying solely on the Scopus database may have excluded relevant studies from other sources or non-English publications. Second, while the analysis covers 2000–2025, data for recent years may be incomplete, and older records could be underrepresented. Third, the findings likely overrepresent high-income countries and English-language research, limiting global generalizability. Additionally, fixed search terms like “family-centered care” may have missed studies using alternative terminology. Citationbased metrics also favor established works, potentially overlooking emerging or niche research. While bibliometrics reveal publication trends, they do not assess study quality or clinical applicability. Finally, the focus on prolific authors and institutions may underrepresent smaller contributors.
Despite these constraints, this analysis offers valuable insights into FCC research evolution. Future studies should incorporate multiple databases, broader language inclusion, and qualitative methods to strengthen findings.

Conclusion

It summarizes the rise of the FCC in NICU over the past 25 years and its results in improving neonatal outcomes and family wellbeing. The result of the bibliometric analysis was a steady increase in the publication of FCC papers, and the United States, Canada, and the United Kingdom being the leading contributors to the global output. Pivotal contributors on the institutional side have been the University of Turku, and on the author side, authors such as Axelín A. Foundational platforms for dissemination of critical FCC research include core journals such as the Advances in Neonatal Care and the Journal of Neonatal Nursing and specialized journals that address niche areas. Keywords that appear most are “female” and “infant,” indicative of research areas in family and neonatal health. The importance of the FCC highlights the global significance of interdisciplinary perspectives and the growing global collaborations. However, research efforts are not equally equitable (i.e., underrepresented regions, disparities in contributions), and so on. This dynamic field is changing, heralding new, innovative, more inclusive ways to provide neonatal care.

Declarations

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About This Article

Received:

May 26, 2025

Accepted:

June 30, 2025

Published Online:

June 30, 2025

Printed:

July 1, 2025