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Lilliesköld S, Lode-Kolz K, Rettedal S, Lindstedt J, Linnér A, Markhus Pike H, Ahlqvist-Björkroth S, Ådén U, Jonas W. Skin-to-Skin Contact at Birth for Very Preterm Infants and Mother-Infant Interaction Quality at 4 Months: A Secondary Analysis of the IPISTOSS Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2344469. [PMID: 38032643 PMCID: PMC10690460 DOI: 10.1001/jamanetworkopen.2023.44469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Importance Good-quality parent-infant interactions have protective effects on infant socio-emotional and behavioral development. These interactions are especially critical for very preterm infants at risk of vulnerabilities related to immaturity. Skin-to-skin contact (SSC) has been found to improve mother-preterm infant interaction behaviors, but few studies exist regarding its benefits when initiated immediately after birth. Objective To determine the effect of immediate SSC at birth for very preterm infants on mother-infant interaction quality at 4 months of corrected age. Design, Setting, and Participants This secondary analysis used data from the Immediate Parent-Infant Skin-to-Skin Study (IPISTOSS), a randomized clinical trial conducted between April 1, 2018, and June 30, 2021, at 3 neonatal units in Sweden and Norway. Participants included very preterm infants (28-33 gestational weeks of age) and their parents. Four-month follow-up was concluded in December 2021. Data analyses were performed on March 16 and September 18, 2023. Intervention Infants were allocated to standard incubator care or SSC with either parent initiated at birth and continued throughout the first 6 hours after birth. Main Outcomes and Measures The primary outcome was mother-infant interaction quality as measured with the Parent-Child Early Relational Assessment (PCERA), based on video recordings of a 5-minute free-play situation with mother-infant dyads at 4 months of corrected age. A multilevel regression analysis was performed. Results This analysis included 71 infants (31 twins [44%]) and 56 mothers. Infants had a mean (SD) gestational age of 31 weeks 3 (1.3) days, and more than half were male (42 [59%]); mothers had a mean (SD) age of 32 (4.9) years. There were 37 infants allocated to standard care and 34 to SSC with either parent after birth. During the first 6 hours after birth, fathers provided more SSC than mothers, with a median (IQR) of 3.25 (2.25-4.5) and 0.75 (0-2.5) hours, respectively. A statistically significant difference in 1 of 5 PCERA subscales (subscale 3: infant positive affect, communicative and social skills) was observed, with higher-quality mother-infant interaction in the SSC group at 4 months (Cohen d = 0.67 [95% CI, 0.17 to 1.17]; P = .01). This effect remained significant when adjusting for primiparity, child sex, and observation setting. Conclusions and Relevance In this study of the effect of immediate parent-infant SSC after very preterm birth, SSC was beneficial for the mother-infant relationship. These findings suggest that immediate SSC should be supported in the clinical setting. Trial Registration ClinicalTrials.gov Identifier: NCT03521310.
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Affiliation(s)
- Siri Lilliesköld
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Karoline Lode-Kolz
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Clinical Neurophysiology, Stavanger University Hospital, Stavanger, Norway
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Siren Rettedal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Johanna Lindstedt
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Agnes Linnér
- Department of Neonatology, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Hanne Markhus Pike
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Sari Ahlqvist-Björkroth
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Ulrika Ådén
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wibke Jonas
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Huang R, Han H, Ding L, Zhou Y, Hou Y, Yao X, Cai C, Li X, Song J, Zhang S, Jiang H. Using the theory of planned behavior model to predict factors influencing breastfeeding behavior among preterm mothers at week 6 postpartum: the mediating effect of breastfeeding intention. Front Psychol 2023; 14:1228769. [PMID: 37744580 PMCID: PMC10514476 DOI: 10.3389/fpsyg.2023.1228769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Exclusive breastfeeding (EBF) in the first 6 weeks postpartum is key to continued breastfeeding. This study aimed to explore the role of EBF-related predictors (particularly breastfeeding intention) in breastfeeding behavior among preterm mothers at week 6 postpartum based on the theory of planned behavior (TPB). Methods A total of 352 mothers of preterm infants were recruited, 340 of whom participated in this study. Prior to discharge, participants completed the Chinese versions of the modified Breastfeeding Attrition Predictive Tool, the Breastfeeding Knowledge Questionnaire (BKQ), the Infant Feeding Intention, and the Edinburgh Postnatal Depression Scale. Responses to the items of the Breastfeeding Behavioral Questionnaire (BBQ) were also collected by telephone at week 6 postpartum. The final analyses included 321 participants who completed the full two-wave data collection. Results The fitness indices of the modified TPB model were acceptable. Breastfeeding knowledge and EBF before discharge positively impacted breastfeeding intention, whereas depression had a negative impact. Before discharge, breastfeeding intention fully mediated the impacts of breastfeeding attitude, social and professional support, knowledge, depression, and EBF on breastfeeding behavior and partially mediated the influence of perceived breastfeeding control on breastfeeding behavior. Conclusion These findings indicate that TPB accurately predicts breastfeeding behavior among preterm mothers at week 6 postpartum, and breastfeeding intention is key to the above-mentioned EBF-related factors and breastfeeding behavior. The findings underline the need for further longitudinal studies and corresponding interventions for preterm mothers with a high risk of EBF attrition.
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Affiliation(s)
- Rong Huang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Han
- School of Medicine, Tongji University, Shanghai, China
| | - Lijing Ding
- School of Medicine, Tongji University, Shanghai, China
| | - Yi Zhou
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yanwen Hou
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiao Yao
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chenting Cai
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaohan Li
- School of Medicine, Tongji University, Shanghai, China
| | - Jianqi Song
- School of Medicine, Tongji University, Shanghai, China
| | - Shuying Zhang
- School of Medicine, Tongji University, Shanghai, China
| | - Hui Jiang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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Dell'Aversana V, Tofani M, Valente D. Emotional Regulation Interventions on Developmental Course for Preterm Children: A Systematic Review of Randomized Control Trials. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030603. [PMID: 36980161 PMCID: PMC10047217 DOI: 10.3390/children10030603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Children born preterm (<37 weeks of gestation) are at increased risk of socio-emotional difficulties. This study aims to determine the effects of rehabilitation intervention on the emotional regulation of children born preterm through a systematic review. We conducted a systematic review according to PRISMA guidelines. The literature screening was carried out on PUBMED, SCOPUS and WEB OF SCIENCE in August 2022. An author identified eligible studies based on predefined inclusion criteria and extracted the data. RCT quality was assessed using the JADAD and PEDro scales. We selected five RCTs for qualitative synthesis, having the common objective of evaluating the changes in emotional regulation after a rehabilitation intervention. Evidence of benefits was found after parent training intervention (PCIT; p < 0.05). Moreover, there was an improvement in day-to-day executive life and fewer behavioral problems after mindfulness intervention. Clinical, but not statistical, efficacy was found for the group-based physiotherapy intervention. In conclusion, parent training and mindfulness interventions can be helpful rehabilitation techniques, but the relatively small sample limited statistical power, so the discovery needs to be interpreted cautiously. Further research on these aspects is recommended.
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Affiliation(s)
- Vincenza Dell'Aversana
- MSc in Rehabilitaiton Sciences for Healthcare Professions, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Tofani
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
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Stoodley C, McKellar L, Ziaian T, Steen M, Fereday J, Gwilt I. The role of midwives in supporting the development of the mother-infant relationship: a scoping review. BMC Psychol 2023; 11:71. [PMID: 36918968 PMCID: PMC10015829 DOI: 10.1186/s40359-023-01092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The mother-infant relationship is complex and dynamic, informing the psychological development of the infant through bonding and attachment. Positive early interactions influence the quality of this relationship. Midwives are well placed to support the developing relationship between the mother and baby, yet there has been limited research exploring the role of the midwife in this context. AIM To explore interventions that have been provided by the midwife which support the development of the maternal-fetal or mother-infant relationship amongst a low-risk population from pregnancy, and up to six weeks postnatal. The review also sought to understand the types of interventions developed, format and delivery, outcomes measured and if cultural considerations had been incorporated. METHODS A scoping review of the research literature was undertaken using the Joanna Briggs Institute framework. Five online databases were searched for relevant articles published in English from 2000 to 2021. FINDINGS Sixteen articles met the inclusion criteria. Three themes emerged: (1) viewing the fetus as separate from the mother, (2) focused activities on the maternal-infant relationship and (3) targeted educational interventions. DISCUSSION Providing focused activities and targeted education during the pre and postnatal periods support the development of the mother-infant relationship. Significantly, there was insufficient research that considered the influence of culture in supporting the mother-infant relationship. CONCLUSION Further research is required to develop interventions that include a diverse sample to ensure culturally appropriate activities can be integrated into care during pregnancy and/or the postnatal period provided by midwives.
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Affiliation(s)
- Cathy Stoodley
- University of South Australia, South Australia, Australia.
| | - Lois McKellar
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Tahereh Ziaian
- University of South Australia, South Australia, Australia
| | - Mary Steen
- University of Northumbria, Newcastle, England
| | | | - Ian Gwilt
- University of South Australia, South Australia, Australia
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Helmer CS, Thornberg UB, Abrahamsson T, Mörelius E. Mothers' experiences of a new early collaborative intervention, the EACI, in the neonatal period: A qualitative study. J Clin Nurs 2022; 32:2892-2902. [PMID: 35702001 DOI: 10.1111/jocn.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
AIM To explore mothers' experiences of the EArly Collaborative Intervention. BACKGROUND Preterm birth puts a considerable emotional and psychological burden on parents and families. Parents to moderate and late premature infants have shorter stays at the neonatal intensive care unit and have described a need for support. The EArly Collaborative Intervention was developed to support parents with preterm infants born between gestational Weeks 30 to 36. In this study, mothers' experiences of the new intervention were explored. DESIGN A qualitative design guided by a reflexive thematic analysis according to Braun and Clarke. Interviews were individually performed with 23 mothers experienced with the EArly Collaborative Intervention. Data were identified, analysed and reported using reflexive thematic analysis. The COREQ checklist was used preparing the manuscript. RESULTS Two main overarching themes were constructed. The first theme, 'mothers' feelings evoked from the EArly Collaborative Intervention' describes the emotions raised by the intervention and how the intervention affected their parental role. Their awareness of the preterm baby's behaviour increased, and the intervention helped the parents to communicate around their baby's needs. The second theme, 'based on the preterm baby's behavior', describes experiences of the provision and the learning process about their preterm baby's needs and communication. The intervention was experienced as helpful both immediately and for future interaction with the baby. CONCLUSIONS Mothers found the intervention to be supportive and encouraging. They came to look upon their baby as an individual, and the new knowledge on how to care and interact with their baby affected both their own and their baby's well-being. Furthermore, the intervention felt strengthening for their relationship with the other parent. RELEVANCE TO CLINICAL PRACTICE The EArly Collaborative Intervention can support parents' abilities as well as their relation to their baby and may thereby contribute to infant development, cognition and well-being.
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Affiliation(s)
- Charlotte Sahlén Helmer
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Crown Princess Victoria Children´s Hospital, Linköping University hospital, Linköping, Sweden
| | - Ulrika Birberg Thornberg
- Department of Rehabilitation Medicine, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Psychology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Thomas Abrahamsson
- Crown Princess Victoria Children´s Hospital, Linköping University hospital, Linköping, Sweden.,Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Evalotte Mörelius
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
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Murphy M, Shah V, Benzies K. Effectiveness of Alberta Family-Integrated Care on Neonatal Outcomes: A Cluster Randomized Controlled Trial. J Clin Med 2021; 10:jcm10245871. [PMID: 34945163 PMCID: PMC8708302 DOI: 10.3390/jcm10245871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Family-Integrated Care (FICare) empowers parents to play an active role as a caregiver for their infant in the neonatal intensive care unit (NICU). This model of care is associated with improved neonatal outcomes, such as improved weight gain and higher breastfeeding rates at discharge in infants admitted to level III NICUs; however, its effectiveness in level II NICUs remains unproven. The objective of this study was to evaluate the effectiveness of the model on neonatal outcomes in a cluster randomized controlled trial conducted in 10 level II NICUs randomized to Alberta FICare or standard care. Mothers and their preterm infants born between 32+0 and 34+6 weeks' gestational age were included. The primary outcome was the proportion of infants who regained their birth weight (BW) after 14 days of life. The analysis included 353 infants/308 mothers at Alberta FICare sites and 365 infants/306 mothers at standard care sites. There was no difference in the proportion of infants who had regained their BW by 14 days between the groups. A lack of perceived improved weight gain trajectory for those in the FICare group is attributed to a shorter length of hospital stay and infants being discharged prior to regaining BW.
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Affiliation(s)
- Madeleine Murphy
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (M.M.); (V.S.)
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (M.M.); (V.S.)
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3300 University Drive NW, Calgary, AB T2N 4N1, Canada
- Correspondence:
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Preventive Intervention Program on the Outcomes of Very Preterm Infants and Caregivers: A Multicenter Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11050575. [PMID: 33946995 PMCID: PMC8145332 DOI: 10.3390/brainsci11050575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
Increased survival in the very preterm population results in a higher risk of developing neurodevelopmental and behavioral disabilities among survivors. We examined the outcomes of very preterm infants and parents after a preventive intervention program of four home visits by a specialized nurse, 5 days, 2 weeks, and 1 month after discharge, respectively, and at CA 2 months, followed by up to 12 times of group sessions between CA 3 and 6 months. Our multicenter randomized controlled trial assessed 138 preterm infants (gestational age ≤30 weeks or birth weight ≤1500 g) enrolled from the three participating hospitals. We randomly allocated the preterm babies to either the intervention or the control group. The primary outcome was the neurodevelopmental outcomes of Bayley-III scores at CA 10 and 24 months. At CA 10 months and 24 months, there were no significant differences between the intervention and control groups in the cognitive, motor, and language domains of Bayley-III scores. In addition, there were no significant differences in the mother’s depression scale, mother–child attachment, and the modified Infant and Toddler Social and Emotional Assessment.
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Comparison of family centered care with family integrated care and mobile technology (mFICare) on preterm infant and family outcomes: a multi-site quasi-experimental clinical trial protocol. BMC Pediatr 2019; 19:469. [PMID: 31791285 PMCID: PMC6886221 DOI: 10.1186/s12887-019-1838-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background Family Centered Care (FCC) has been widely adopted as the framework for caring for infants in the Neonatal Intensive Care Unit (NICU) but it is not uniformly defined or practiced, making it difficult to determine impact. Previous studies have shown that implementing the Family Integrated Care (FICare) intervention program for preterm infants in the NICU setting leads to significant improvements in infant and family outcomes. Further research is warranted to determine feasibility, acceptability and differential impact of FICare in the US context. The addition of a mobile application (app) may be effective in providing supplemental support for parent participation in the FICare program and provide detailed data on program component uptake and outcomes. Methods This exploratory multi-site quasi-experimental study will compare usual FCC with mobile enhanced FICare (mFICare) on growth and clinical outcomes of preterm infants born at or before 33 weeks gestational age, as well as the stress, competence and self-efficacy of their parents. The feasibility and acceptability of using mobile technology to gather data about parent involvement in the care of preterm infants receiving FCC or mFICare as well as of the mFICare intervention will be evaluated (Aim 1). The effect sizes for infant growth (primary outcome) and for secondary infant and parent outcomes at NICU discharge and three months after discharge will be estimated (Aim 2). Discussion This study will provide new data about the implementation of FICare in the US context within various hospital settings and identify important barriers, facilitators and key processes that may contribute to the effectiveness of FICare. It will also offer insights to clinicians on the feasibility of a new mobile application to support parent-focused research and promote integration of parents into the NICU care team in US hospital settings. Trial registration ClinicalTrials.gov, ID NCT03418870. Retrospectively registered on December 18, 2017.
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Lyndon A, Baer RJ, Gay CL, El Ayadi AM, Lee HC, Jelliffe-Pawlowski L. A population-based study to identify the prevalence and correlates of the dual burden of severe maternal morbidity and preterm birth in California. J Matern Fetal Neonatal Med 2019; 34:1198-1206. [PMID: 31170837 DOI: 10.1080/14767058.2019.1628941] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Prior studies have documented associations between preterm birth and severe maternal morbidity (SMM) but the prevalence and correlates of dual burden are not adequately understood, despite significant family implications. PURPOSE To describe the prevalence and correlates of the dual burden of SMM and preterm birth and to understand profiles of SMM by dual burden of preterm birth.Approach: This retrospective cohort study included all California live births in 2007-2012 with gestations 20-44 weeks and linked to a birth cohort database maintained by the California Office of Statewide Health Planning and Development (n = 3,059,156). Dual burden was defined as preterm birth (<37 weeks) with severe maternal morbidity (SMM, defined by Centers for Disease Control). Predictors for dual burden were assessed using Poisson logistic regression, accounting for hospital variance. RESULTS Rates of preterm birth and SMM were 876 and 140 per 10,000 births, respectively. The most common indications of SMM both with and without preterm birth were blood transfusions and a combination of cardiac indications. One-quarter of women with SMM experienced preterm birth with a dual burden rate of 37 per 10,000 births. Risk of dual burden was over threefold higher with cesarean birth (primiparous primary aRR = 3.3, CI = 3.0-3.6; multiparous primary aRR = 8.1, CI = 7.2-9.1; repeat aRR = 3.9, CI = 3.5-4.3). Multiple gestation conferred a six-fold increased risk (aRR = 6.3, CI = 5.8-6.9). Women with preeclampsia superimposed on gestational hypertension (aRR = 7.3, CI = 6.8-7.9) or preexisting hypertension (aRR = 11.1, CI = 9.9-12.5) had significantly higher dual burden risk. Significant independent predictors for dual burden included smoking during pregnancy (aRR = 1.5, CI = 1.4-1.7), preexisting hypertension without preeclampsia (aRR = 3.3, CI = 3.0-3.7), preexisting diabetes (aRR = 2.6, CI = 2.3-3.0), Black race/ethnicity (aRR = 2.0, CI = 1.8-2.2), and prepregnancy body mass index <18.5 (aRR = 1.4, CI = 1.3-1.5). CONCLUSIONS Dual burden affects 1900 California families annually. The strongest predictors of dual burden were hypertensive disorders with preeclampsia and multiparous primary cesarean.
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Affiliation(s)
- Audrey Lyndon
- Department of Family Health Care Nursing, San Francisco School of Nursing, University of California, San Francisco, CA, USA
| | - Rebecca J Baer
- Department of Pediatrics, University of California, San Diego, CA, USA.,California Preterm Birth Initiative, University of California, San Francisco, CA, USA
| | - Caryl L Gay
- Department of Family Health Care Nursing, San Francisco School of Nursing, University of California, San Francisco, CA, USA.,California Preterm Birth Initiative, University of California, San Francisco, CA, USA
| | - Alison M El Ayadi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Henry C Lee
- Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Stanford, CA, USA
| | - Laura Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
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Sabnis A, Fojo S, Nayak SS, Lopez E, Tarn DM, Zeltzer L. Reducing parental trauma and stress in neonatal intensive care: systematic review and meta-analysis of hospital interventions. J Perinatol 2019; 39:375-386. [PMID: 30659239 PMCID: PMC7067599 DOI: 10.1038/s41372-018-0310-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/08/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To classify NICU interventions for parental distress and quantify their effectiveness. STUDY DESIGN We systematically reviewed controlled studies published before 2017 measuring NICU parental distress, defined broad intervention categories, and used random-effects meta-analysis to quantify treatment effectiveness. RESULTS Among 1643 unique records, 58 eligible trials predominantly studied mothers of preterm infants. Interventions tested in 22 randomized trials decreased parental distress (p < 0.001) and demonstrated improvement beyond 6 months (p < 0.005). In subgroup analyses, complementary/alternative medicine and family-centered instruction interventions each decreased distress symptoms (p < 0.01), with fathers and mothers improving to similar extents. Most psychotherapy studies decreased distress individually but did not qualify for meta-analysis as a group. CONCLUSION NICU interventions modestly reduced parental distress. We identified family-centered instruction as a target for implementation and complementary/alternative medicine as a target for further study. Investigators must develop psychosocial interventions that serve NICU parents at large, including fathers and parents of full-term infants.
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Affiliation(s)
- Animesh Sabnis
- Department of Pediatrics, Division of Neonatology & Developmental Biology, University of California-Los Angeles (UCLA), Los Angeles, CA, USA.
| | - Sofia Fojo
- Keck School of Medicine of University of Southern California
| | | | - Elizabeth Lopez
- Department of Pediatrics, Division of Neonatology & Developmental Biology, University of California—Los Angeles (UCLA), Los Angeles, California
| | - Derjung M. Tarn
- Department of Family Medicine, University of California—Los Angeles (UCLA), Los Angeles, California
| | - Lonnie Zeltzer
- Departments of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences, University of California—Los Angeles (UCLA), Los Angeles, California
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11
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Puthussery S, Chutiyami M, Tseng PC, Kilby L, Kapadia J. Effectiveness of early intervention programs for parents of preterm infants: a meta-review of systematic reviews. BMC Pediatr 2018; 18:223. [PMID: 29986683 PMCID: PMC6038283 DOI: 10.1186/s12887-018-1205-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/02/2018] [Indexed: 01/17/2023] Open
Abstract
Background Various intervention programs exist for parents of preterm babies and some systematic reviews (SRs) have synthesised the evidence of their effectiveness. These reviews are, however, limited to specific interventions, components, or outcomes, and a comprehensive evidence base is lacking. The aim of this meta-review was to appraise and meta-synthesise the evidence from existing SRs to provide a comprehensive evidence base on the effectiveness of interventions for parents of preterm infants on parental and infant outcomes. Methods We conducted a comprehensive search of the following databases to identify relevant SRs: Cochrane library, Web of science, EMBASE, CINAHL, British Nursing Index, PsycINFO, Medline, ScienceDirect, Scopus, IBSS, DOAJ, ERIC, EPPI-Centre, PROSPERO, WHO Library. Additional searches were conducted using authors’ institutional libraries, Google Scholar, and the reference lists of identified reviews. Identified articles were screened in two stages against an inclusion criteria with titles and abstracts screened first followed by full-text screening. Selected SRs were appraised using the AMSTAR tool. Extracted data using a predesigned tool were synthesised narratively examining the direction of impact on outcomes. Results We found 11 SRs eligible for inclusion that synthesised a total of 343 quantitative primary studies. The average quality of the SRs was ‘medium’. Thirty four interventions were reported across the SRs with considerable heterogeneity in the structural framework and the targeted outcomes that included maternal-infant dyadic, maternal/parental, and infant outcomes. Among all interventions, Kangaroo Care (KC) showed the most frequent positive impact across outcomes (n = 19) followed by Mother Infant Transaction Program (MITP) (n = 14). Other interventions with most consistent positive impact on infant outcomes were Modified-Mother Infant Transaction Program (M-MITP) (n = 6), Infant Health and Development Program (IHDP) (n = 5) and Creating Opportunities for Parent Empowerment (COPE) (n = 5). Overall, interventions with both home and facility based components showed the most frequent positive impact across outcomes. Conclusions Neonatal care policy and planning for preterm babies should consider the implementation of interventions with most positive impact on outcomes. The heterogeneity in interventions and outcomes calls for the development and implementation of an integrated program for parents of preterm infants with a clearly defined global set of parental and infant outcomes.
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Affiliation(s)
- Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
| | - Muhammad Chutiyami
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK
| | - Pei-Ching Tseng
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK
| | - Lesley Kilby
- Neonatal Unit, Luton and Dunstable Hospital, Lewsey Rd, Luton, LU4 0DZ, UK
| | - Jogesh Kapadia
- Neonatal Unit, Luton and Dunstable Hospital, Lewsey Rd, Luton, LU4 0DZ, UK
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"The effects of family-centered physiotherapy on the cognitive and motor performance in premature infants". Infant Behav Dev 2017; 49:214-219. [PMID: 28957689 DOI: 10.1016/j.infbeh.2017.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/11/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the effects of family centered physiotherapy according to the neurodevelopmental treatment (NDT) principles on mental and motor performance in premature infants. METHODS A total of 156 infant, ≥24/36 week+6days gestational age included in the study. All the infants were diagnosed by a child neurologist and referred to psychology and physiotherapy department for their neurodevelopmental assessment and treatment. Bayley Scale of Infant II (BSI-II) was used for neurodevelopmental assessment and Alberta Infant Motor Scale (AIMS) was used for assessing their motor performance. Seventy-eight of the infants were in the study group and 76 were recruited as age matched controls according to the classification of their gestational age. Family centered physiotherapy according to the neurodevelopmental treatment principles was used as an intervention and all the mothers are trained accordingly. RESULTS Cognitive Development Scores and Motor Development Scores of Bayley II were recorded for the 3., 6., 9., and 12 months respectively. Between the 3. and 12. month of gestational age, within-groups measurements in both Cognitive Development Scores (p<0.001) and Motor Development Scores (p<0.001) were significantly increased. However, the improvements in both Cognitive Development Scores (p=0.059) and Motor Development Scores (p=0.334) between the groups was not different. CONCLUSION Family centered physiotherapy with NDT principles may not be enough to improve motor and cognitive performance in preterm infants at the first year of age. For supporting the motor and cognitive development of the preterm infants other intervention modalities also should be considered.
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Mendelson T, Cluxton-Keller F, Vullo GC, Tandon SD, Noazin S. NICU-based Interventions To Reduce Maternal Depressive and Anxiety Symptoms: A Meta-analysis. Pediatrics 2017; 139:peds.2016-1870. [PMID: 28223373 DOI: 10.1542/peds.2016-1870] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Parents whose infants are being treated in the NICU are at high risk for depression and anxiety, with negative implications for parenting and infant development. OBJECTIVE We conducted a systematic review and meta-analysis of NICU-based interventions to reduce maternal depressive or anxiety symptoms. DATA SOURCES PubMed, Embase, PsychInfo, Cochrane, and CINAHL were searched for relevant studies. Reference lists from selected studies were reviewed. STUDY SELECTION Inclusion criteria included randomized controlled design, a parent-focused intervention delivered in the NICU, valid maternal depressive or anxiety symptom measures at pre- and postintervention, and publication in a peer-reviewed journal in English. DATA EXTRACTION Data extraction was conducted independently by 2 coders. RESULTS Twelve studies met inclusion criteria for qualitative review; 2 were excluded from quantitative analyses for high risk of bias. Fixed- and random-effects models, with 7 eligible studies assessing depressive symptoms, indicated an effect of -0.16 (95% confidence interval [CI], -0.32 to -0.002; P < .05) and, with 8 studies assessing anxiety symptoms, indicated an effect of -0.12 (95% CI, -0.29 to 0.05; P = .17). The subset of interventions using cognitive behavioral therapy significantly reduced depressive symptoms (effect, -0.44; 95% CI, -0.77 to -0.11; P = .01). LIMITATIONS The small number and methodological shortcomings of studies limit conclusions regarding intervention effects. CONCLUSIONS Combined intervention effects significantly reduced maternal depressive but not anxiety symptoms. The evidence is strongest for the impact of cognitive behavioral therapy interventions on maternal depressive symptoms.
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Affiliation(s)
| | | | | | - S Darius Tandon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sassan Noazin
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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