Effectiveness of early interventions for parental sensitivity following preterm birth: a systematic review protocol

Effectiveness of Care for Child Development Program on the Sensitivity and Responsiveness Skills of Mothers

OBJECTIVES

The present study was done to analyze the impact of the "care for child development" program on the sensitivity and responsiveness skills among mothers of children at risk of developmental delay.

MATERIALS & METHODS

This study was a quasi-experimental research with a pretest-posttest design and experimental and control groups. The statistical population included all mothers with children at risk of developmental delay in Tabriz. Fifty mothers were selected through purposive sampling. Then, they were divided into two groups of 25 cases (one experimental group and one control group) using simple random sampling. The experimental group received training about the "care for child development" program, while the control group received no training. The Social-Emotional Assessment/Evaluation Measure Family Profile (SEAM TM family profile) and Maternal Caregiving Quality Scale were the research measurement tools. The obtained data were evaluated by analysis of covariance (ANCOVA) and independent t-test using SPSS software version 20.

RESULTS

There was a significant difference between the experimental and control groups in maternal caregiving quality and responsiveness, provision of appropriate activities, predictable programs, and provision of play environment and safe home (P <0.05).

CONCLUSION

The results showed that the care for child development program has positive effects on sensitivity and responsiveness skills of mothers of children at risk of developmental delays and can be considered and applied as a practical plan in national health policies.

The Social Organization of Neonatal Nurses' Feeding Work

PURPOSE

We report findings from an institutional ethnography (IE) of nurses' work of feeding infants within an increasingly technical organization of NICUs.

SAMPLE

Five primary informants; 18 secondary informants.

DESIGN

The institutional ethnographic approach included field observations, interviews, and phone and e-mail conversations. Our analysis followed accounts of what actually happened within the textual organization of nurses' work.

MAIN OUTCOME

Nurses' feeding practices are directed by protocols that arise within multiple documentation systems and clinical technologies. These systems produce barriers to nurses' efforts to skillfully feed infants.

RESULTS

Prioritization of quality and safety perspectives can obscure and constrain the ordinary yet critical clinical reasoning neonatal nurses employ during feeding work. Clinical technologies that have been developed to improve safety can paradoxically disrupt the ability of nurses to respond in the moment to neonatal feeding cues. This finding provides nurses, leaders, and policymakers with insight into why policies and procedures may not be followed as expected.

South Korean nurses' lived experiences supporting maternal postpartum bonding in the neonatal intensive care unit

Purpose: Preterm birth and admission to a neonatal intensive care unit (NICU) can disrupt the parent-infant bonding relationship. Although neonatal nurses are in the best position to support maternal postpartum bonding in the NICU, few qualitative studies have described their challenges, strategies, and lived experiences. Methods: This study aimed to explore and understand the experiences and perspectives of nurses supporting infants hospitalized in the NICU and their families in relation to the bonding process. We conducted a qualitative study using interpretive phenomenological analysis with 12 in-depth, semi-structured interviews recorded and transcribed verbatim between April and November 2018. We thematically analysed the data using NVivoTM software. Results: Two themes emerged: (1) Being a bridge between separated mothers and infants (five subthemes); (2) Challenges in providing supportive care for maternal postpartum bonding in the NICU (three subthemes). Conclusions: Nurses have a variety of experiences regarding maternal postpartum bonding; however, the clinical reality of NICUs limits support for bonding formation. Although nurses face challenges (e.g., institutional policies, insufficient resources, training) when supporting maternal postpartum bonding, they act as the bridge between mothers and infants, becoming advocates for NICU families and taking care of their growth and developmental needs as caregivers.

Promoting attachment between parents and neonates despite the COVID-19 pandemic

Social distancing is the only option available during the COVID‐19 pandemic until a vaccine is developed. However, this is having a major impact on human relationships and bonding between parents and neonates is a major concern. Separation during this health emergency could have lifelong consequences for offspring, and there are even greater concerns if newborn infants are sick or vulnerable and need intensive care. We look at how bonding can be safely supported and maintained without risking infecting neonates, by comparing the international guidelines and proposing safe actions within those frameworks.

A guided participation nursing intervention to theraupeutic positioning and care (GP_Posit) for mothers of preterm infants: protocol of a pilot randomized controlled trial

Background

In the NICU, interventions intended to enhance maternal sensitivity are indicated in order to optimize preterm infant development and long-term mother-infant attachment. A novel nursing intervention was developed following a theory-oriented methodology and is based upon the guided participation theory for mothers to participate in their preterm infant's therapeutic POSITioning and care (GP_Posit). The primary objective of this study is to evaluate the feasibility and acceptability of (i) the study design; and (ii) the experimental GP_Posit nursing intervention during NICU hospitalization. The secondary objective is to estimate the preliminary effects of GP_Posit on maternal and preterm infant outcomes.

Methods

A pilot parallel-group randomized clinical trial (RCT) was designed where mother-preterm infant dyads are being recruited and randomized to a control group (usual care) or experimental group (GP_Posit intervention). Data collection includes feasibility and acceptability data as well as preliminary effects on maternal sensitivity and infant neurodevelopment. Ethical approval from the University Hospital ethical board was obtained in January 2018 (2017-1540).

Discussion

Data collection for this pilot study is expected to end in 2020. Results of this pilot study will inform about the feasibility and acceptability of the study design and GP_Posit intervention, a nursing intervention having the potential to favor maternal sensitivity and infant neurodevelopment in the NICU and guide the elaboration of a large-scale RCT.

Trial registration

clinicaltrial.gov, NCT03677752. Registered 19 September 2018.

Attachment and relationship-based interventions for families during neonatal intensive care hospitalization: a study protocol for a systematic review and meta-analysis

BACKGROUND

Attachment in the parent-infant dyads is fundamental for growth and development of children born prematurely. However, the natural process of attachment is interrupted just after preterm birth, and emotional and physical detachment, limited social interaction, and a traumatic, technologically heavy environment in a neonatal intensive care unit (NICU) may result in impaired attachment or bonding. To our knowledge, few studies have evaluated the effectiveness of interventions aimed at enhancing attachment, bonding, and relationships between parents and their preterm infants during the infant's hospitalization in the NICU. This study aims to perform a comprehensive systematic review and a meta-analysis survey of the effects of attachment- and relationship-based interventions in the NICU.

METHOD

A comprehensive literature review will be conducted in the following databases: MEDLINE, CINAHL, PubMed, EMBASE (OVID), Scopus, PsycINFO (OVID), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science. Selected studies will be published in English, in the last 20 years, from 1999 onwards. All studies of randomized controlled trials (e.g., parallel groups, cluster) will be included. We will consider studies evaluating attachment- and relationship-based interventions (e.g., skin-to-skin contact, parental involvement in infant care) versus a comparator (standard of care). The primary outcome will be maternal attachment. Secondary outcomes will include infants' growth and development, family health, and parenting experience. Data extraction from eligible studies will be conducted independently by two experts who will compare their data. The Cochrane risk of bias tool will be applied to the selected studies. If data permits, we will conduct random effects meta-analysis where appropriate. Subgroup and additional analyses will be conducted to explore the potential sources of heterogeneity considering gender of parents, infants' sex, and gestational age. Data synthesis will be carried out using the RevMan 5.3 software. Publication bias will be assessed with the graphical funnel plot method and the Egger test. The quality of the evidence will be rated using the methods of the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group.

DISCUSSION

The results of this systematic review will discuss the types of attachment- or relationship-based interventions that are effective for facilitating family health outcomes and the babies' growth and development and will contribute to establishing new evidence in neonatal and family-centered care by providing scientific guidance for clinical practice and further research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019145834.

Factors influencing promotive behaviours in mothers of Indonesian children with avoidant restrictive food intake disorder

OBJECTIVES

This study aimed to identify predictors of promotive behaviours in mothers of Indonesian children with avoidant restrictive food intake disorder (ARFID).

METHODS

A cross-sectional descriptive survey was administered to 245 mothers who were caring for children with ARFID. Data were collected with a self-administered questionnaire. For descriptive data analysis, independent t-test, Mann-Whitney U test, one-way analysis of variance, Kruskal-Wallis, and multiple linear regression were employed.

RESULTS

The factors related to promotive behaviours in these mothers were embodied in mutual parenting, especially in terms of childcare (p = 0.001 < 0.05) and interaction with children (p = 0.001 < 0.05. Additionally, multiple linear regression showed that mutual parenting remained at the communication domain, with children as the primary predictor (β 0.401, p 0.001), where the number of children (β -0.201, p = 0.008) influenced the promotive behaviours.

CONCLUSIONS

This study found that the number of children and mutual parenting in interacting with children were key factors that influenced promotive behaviours in mothers of children with ARFID. We suggest that nursing interventions can potentially improve promotive behaviours in this population.

Socio-demographic Determinants and the Family Ability to Care for Children with Avoidant Restrictive Food Intake Disorder (ARFID)

Background: The ability of families to care for avoidant restrictive food intake disorder children is still low. There is only few studies that examined relationship between family factor to ability to care children with avoidant restrictive food intake disorder. The purpose of this study was to identify the influence of socio-demographic factors on the ability of families to represent children with avoidant restrictive food intake disorder.Method: The study design was cross-sectional, and the majority of samples were gathered using the rule of the thumb, totaling 245 participants. The sampling technique used a type of multistage sampling. Data were collected by questionnaire. We then conducted an analysis of the univariate data using frequency distribution, while for the bivariate data, we used the chi-square technique. All of the data was processed using IBM SPSS 23.0 statistics.Results: The results showed that the ability of care from the families (health promotion behavior) of children with avoidant restrictive food intake disorder  was influenced by the socio-demographic factors, namely maternal age (p= 0.010), the number of children (p= 0.047) and education (p= 0.036).Conclusion: Young mothers need appropriate guidance and direction through good health education. Good health education in young mothers can reduce the pressure faced by the mothers when caring for their children with avoidant restrictive food intake disorder. Health promotion behavior is influenced by maternal education and maternal age. Through good mother's education, the mother will be able to provide a good pattern of care to children who experience avoidant restrictive food intake disorder.