Early Literacy Research Library (ELRL) - Article

Implementation of a Pilot Program of Reach Out and Read in the Neonatal Intensive Care Unit: A Quality Improvement Initiative

Levesque, B.M., et al. (2018) Implementation of a Pilot Program of Reach Out and Read® in the Neonatal Intensive Care Unit: A Quality Improvement Initiative. Journal of Perinatology, 38, 759–766.,

Access: Institutional Access

Publication year


study description

Quality improvement pilot initiative.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Infant/Newborn , Neonatal/NICU

Exposures, Outcomes, Other

Implementation and Evaluation , Language and Literacy Development , Reading Frequency


We report on our experience initiating ROR in the NICU, a pediatric population not previously targeted until our request, to increase language exposure for our preterm infants.


Reach Out and Read (ROR) from infancy.

outcomes evaluated

Language exposure and caregiver-infant reading frequency.


The Boston Medical Center (BMC) NICU is a 21-bed unit in an urban, non-profit, safety-net hospital in Boston, MA, with ~2700 deliveries per year. BMC serves a diverse, low income population. At the time of this initiative, the NICU was a 2 room, “open bay” style unit.


We introduced Reach Out and Read (ROR) in the NICU as a quality improvement initiative to increase language exposure. Measures included availability of books, accessibility of parents, and enrollment of infants, percent infants read to by their parents, and data from parental surveys.

sample size

n=98 (total infants); n=40 (discharged on or before ROR launched); n=58 (discharged after)


Process Measures: percent of infants for whom we have books in mother’s native language, average daily visits by mother and/or father during hospitalization, and percent of eligible infants who were enrolled in ROR.


Balancing Measures: parental feedback from an anonymous survey and informal nursing feedback.


Measure of Days Spent in the NICU: EMR review.


98 infants were included (40 before, 58 after). We obtained books in the mother’s language for 95% of infants, 82% eligible infants were enrolled, and 70% read to their infants (mean of 0.45 ± 0.35 times/day). Surveyed parents enjoyed reading, noted positive effect(s), and intended to read post-discharge.


We launched a well-received pilot ROR program in the NICU and reached our goal of ≥50% infants being read to by their parents. Further study is needed to assess the impact of reading in the NICU on parents and infants.


The method of tracking reading using a calendar and stickers was limited. Some families enthusiastically used the calendar, but others did not. Some calendars were lost at the time of discharge. We initially planned to wait until we could add a field in our EMR to document reading, but this would have delayed our launch significantly. While we reached our goal of 50% of infants being read to by their parents in the NICU, we believe this is an underestimation. We did not inquire about parental literacy at the time of enrollment; instead, we offered books that ranged greatly in complexity...Our small sample size was a limitation. Requiring a formal enrollment prior to provision of books allowed us to gather useful information, but may have also limited the numbers enrolled for this pilot effort. Other limitations included the inability to measure the length or quality of parental visits and the lack of follow-up post-discharge.