BackgroundPreterm birth remains a global health issue, and prematurity poses a significant health risk to neonates and often requires prolonged care in the Neonatal Intensive Care Unit (NICU). This experience can be overwhelming for parents, who must adapt emotionally and practically to the demands of caring for their fragile infants. Investigating parental adaptation processes in caring for preterm neonates is essential for designing effective parental involvement in the Neonatal Intensive Care Unit. ObjectiveThis study aimed to explore parents’ adaptation process in caring for preterm neonates in the Neonatal Intensive Care Units.MethodsA descriptive qualitative design was used. Data were collected through in-depth, semi-structured interviews with purposively selected parents of preterm neonates admitted to six hospitals in Rwanda. Interviews were conducted with 24 participants (4 per hospital), and 6 focus group discussions were held (1 per hospital). Recording, transcription, and thematic analysis were used to identify emerging themes related to parental adaptation. ResultsFive major themes emerged: 1) Initial Emotional response, 2) Adaptation and coping mechanisms, 3) Adaptation of knowledge and skills in caring for preterm neonates 4) Challenges and barriers in the adaptation process. The fifth is healthcare system adaptation to address parental experiences in NICU settings.ConclusionThe parental adaptation process in the NICU is dynamic, shaped by emotional, social, and institutional factors. The adaptation process, clear communication from healthcare providers, and structured parental involvement in neonatal care can significantly ease this transition. Rwanda J Med Health Sci 2026;9(2):382-399