Limitations
This study had several limitations. First, the sample size is small and homogeneous (largely white and well-educated). This intervention may not target parents who cannot afford or do not have access to the Internet. Before starting the study, we surveyed NICU parents (n = 27) regarding access to the Internet and found that 95% had access either via home computer or cellphone. Plans are in place to lend iPhones or iPads (Apple Corp) to parents for the duration of the study and to supply parents with temporary wi-fi cards in order to expand enrollment to include any NICU parent. A second limitation was that our method for tracking the number of updates (reliance on providers to record when updates were done) was inaccurate. An objective measure will be necessary in future studies in order to determine how often updates are actually done. Third, we did not formally track the rationales of parents who declined to participate, although the most common reasons given by parents informally were that parents did not have reliable access to the Internet or were present on the unit enough that an additional update was not needed. A better understanding of parents' reasons for not participating is certainly necessary and worth consideration in future studies. Finally, with our small sample size, we were unable to discern differences in terms of feasibility, interest in enrollment, or usefulness of videoconference updates based on parents' race, distance from the hospital, or severity of illness. Future studies are needed to flesh out these differences in order to ensure that interventions such as this reach the populations who can most benefit.