UNLABELLED

Effective leadership is essential in neonatal intensive care units (NICUs), where complex, high-stakes environments require coordinated multidisciplinary teamwork. Strong leadership improves clinical outcomes, team performance, and staff well-being. This systematic review assesses various leadership models and interventions in NICUs to identify best practices and areas for future research. A systematic search was conducted on PubMed, Web of Science, and Scopus, covering studies published from 2010 to October 2024. Articles were screened using the PRISMA guidelines, and inclusion criteria focused on primary studies in NICU settings evaluating leadership interventions. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale. Nine studies from diverse countries and research designs were included. Leadership interventions varied from simulation-based training programs to co-leadership models. High-fidelity simulation boot camps significantly improved self-perceived skills, teamwork, and leadership confidence among trainees. While most studies reported positive impacts on team performance and patient safety, one large-scale quality improvement program showed no significant improvement in clinical outcomes for very-low-birth-weight infants.

CONCLUSION

The findings emphasize that leadership interventions, including structured training and co-leadership, enhance team dynamics and clinical outcomes in NICUs. However, variability in study designs and reliance on self-reported data highlight the need for standardized evaluation methods. Future research should focus on long-term impacts, cross-context comparisons, and refining leadership frameworks to address the unique challenges of NICU settings. Promoting effective leadership not only improves patient care but also fosters a resilient and collaborative work environment.

WHAT IS KNOWN

• Leadership is crucial in NICUs, where complex, high-stakes environments demand coordinated, multidisciplinary teamwork. Strong leadership enhances clinical outcomes, team performance, and staff well-being. • No systematic review of leadership interventions in neonatal care has been conducted to date.

WHAT IS NEW

• Recent studies highlight a range of tools, including simulation-based training programs and co-leadership models. • High-fidelity simulations have been shown to significantly improve participants' self-perceived skills, teamwork, and leadership confidence.