Effectiveness of an Educational Video in Maternity Wards to Prevent Self-Reported Shaking and Smothering during the First Week of Age: A Cluster Randomized Controlled Trial

Abstract

This study aimed to investigate whether watching an educational video on infant crying and the dangers of shaking and smothering within 1 week after delivery at maternity wards reduces self-reported shaking and smothering, at a 1-month health checkup. A cluster randomized controlled trial, stratified by area and hospital function, was employed in 45 obstetrics hospitals/clinics in Osaka Prefecture, Japan. In the intervention group, mothers watched an educational video on infant crying and the dangers of shaking and smothering an infant, within 1 week of age, during hospitalization at maternity wards, without blinding on group allocation. Control group received usual care. A total of 4722 (N = 2350 and 2372 for intervention and control group, respectively) mothers who delivered their babies (still birth and gestational age < 22 weeks were excluded) between October 1, 2014, and January 31 were recruited. Outcomes were self-reported shaking and smothering behaviors, knowledge on infant crying and shaking, and behaviors to cope with infant crying, assessed via a questionnaire at a 1-month health checkup. In all, 2718 (N = 1078 and 1640) responded to the questionnaire (response rate: 58.3%), and analytic sample size was 2655 (N = 1058 and 1597 for intervention and control group, respectively). Multilevel analysis was used to adjust for correlation within the cluster. Prevalence of shaking was significantly lower in the intervention group (0.19%) than in the control group (1.69%). Intention-to-treat analysis showed an 89% reduction in the reported prevalence of self-reported shaking (OR: 0.11, 95% CI: 0.02–0.53) due to watching the educational video. However, self-reported smothering behavior showed no significant reduction (OR: 0.66, 95% CI: 0.27–1.60). No side effects were reported. Watching an educational video on infant crying and the dangers of shaking and smothering within 1 week after delivery at maternity wards reduced self-reported shaking at 1 month of age. UMIN Clinical Trial Registry UMIN000015558.

The Effectiveness of Parenting Programs in Preventing Abusive Head Trauma: A Systematic Review and Meta-Analysis

“…The result showed that mothers’ knowledge of the peak of crying improved in the intervention group than in the control group (percentage of improvement: 31% vs. 13%, p = .026). The effectiveness of The Period of PURPLE Crying ® evaluated by Barr, Rivara, et al (2009) and Fujiwara, Isumi, Sampei, Miyazaki, et al (2020) also showed improved knowledge of mothers of newborns on normal crying patterns and dangers of shaking. However, in some studies, the same program did not improve parents’ knowledge of the dangers of shaking (Barr, Barr, et al, 2009; Fujiwara et al, 2012).…”

“…On the contrary, Barr, Barr, et al (2009) and Fujiwara et al (2012) reported an insignificant difference in the frequency of maternal behaviors, including taking a break in response to inconsolable crying, between the intervention and control groups. Similarly, parents who received AHT preventive programs involving strategies for responding to inconsolable crying may either use more self-talk to gain control over their emotions (Fujiwara, Isumi, Sampei, Yamada, et al, 2020; Morrill et al, 2015) or not (Barr, Barr, et al, 2009; Fujiwara, Isumi, Sampei, Miyazaki, et al, 2020). A synthesis of the effectiveness of AHT preventive parenting programs can provide a basis to optimize the design of future research and interventions to prevent AHT.…”

From Research to Practice in OBGYN: How to Critically Interpret Studies in Implementation

“…Example: A cluster-randomized trial in Japan examined the impact of a postpartum educational video on rates of selfreported shaking and smothering of newborns. 39 Forty-five obstetric units were randomized to receive or not receive the intervention. Analysis was performed by patient, comparing 2350 individuals in the intervention group to 2372 individuals in the no intervention group.…”

“…Example : A cluster-randomized trial in Japan examined the impact of a postpartum educational video on rates of self-reported shaking and smothering of newborns 39. Forty-five obstetric units were randomized to receive or not receive the intervention.…”

“…Yet, analyses are still often performed at the patient level in order to increase power and demonstrate a significant result. High quality work in implementation research will take the “unit of analysis” or “clustering” into account when performing statistical analyses. Example : A cluster-randomized trial in Japan examined the impact of a postpartum educational video on rates of self-reported shaking and smothering of newborns 39. Forty-five obstetric units were randomized to receive or not receive the intervention.…”