Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis

Abstract

BackgroundPreterm infants are at greater risk for neurodevelopmental disabilities than full term infants. Interventions supporting parents to improve the quality of the infant’s environment should improve developmental outcomes for preterm infants. Many interventions that involve parents do not measure parental change, nor is it clear which intervention components are associated with improved parental outcomes. The aim of this review was to categorize the key components of early intervention programs and determine the direct effects of components on parents, as well as their preterm infants.MethodsMEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Database of Systematic Reviews were searched between 1990 and December 2011. Eligible randomized controlled trials (RCTs) included an early intervention for preterm infants, involved parents, and had a community component. Of 2465 titles and abstracts identified, 254 full text articles were screened, and 18 met inclusion criteria. Eleven of these studies reported maternal outcomes of stress, anxiety, depressive symptoms, self-efficacy, and sensitivity/responsiveness in interactions with the infant. Meta-analyses using a random effects model were conducted with these 11 studies.ResultsInterventions employed multiple components categorized as (a) psychosocial support, (b) parent education, and/or (c) therapeutic developmental interventions targeting the infant. All interventions used some form of parenting education. The reporting quality of most trials was adequate, and the risk of bias was low based on the Cochrane Collaboration tool. Meta-analyses demonstrated limited effects of interventions on maternal stress (Z = 0.40, p = 0.69) and sensitivity/responsiveness (Z = 1.84, p = 0.07). There were positive pooled effects of interventions on maternal anxiety (Z = 2.54, p = 0.01), depressive symptoms (Z = 4.04, p <.0001), and self-efficacy (Z = 2.05, p = 0.04).ConclusionsPositive and clinically meaningful effects of early interventions were seen in some psychosocial aspects of mothers of preterm infants. This review was limited by the heterogeneity of outcome measures and inadequate reporting of statistics.Implications of key findingsInterventions for preterm infants and their mothers should consider including psychosocial support for mothers. If the intervention involves mothers, outcomes for both mothers and preterm infants should be measured to better understand the mechanisms for change.

Music Therapy for Preterm Infants and Their Parents: A Meta-analysis

“…17,21 Elevated maternal anxiety is associated with postpartum depression 38 and impaired parenting 39 in mothers of preterm infants, whereas reduction in maternal anxiety is associated with improvements in child development during the first 2 years of life. 40 The 3 studies included in the metaanalysis of maternal anxiety all used live music in conjunction with KC, demonstrating greater improvements than with KC alone. These results support the beneficial impact of interventions that instate the parent in a nurturing and caregiving role (provider of KC) that includes engagement in live music.…”

Envolvimento paterno: validade interna da versão brasileira do Inventory of Father Involvement

“…Apesar de já evidenciada a relevância do envolvimento paterno, ainda se nota a falta de intervenções direcionadas para o aprimoramento específico da atuação do pai junto a seu filho (Benzies, Magil-Evans, Hayden, & Ballantyne, 2013;Flippin & Crais, 2011), bem como a fragilidade metodológica desses programas, quando existentes (Bronte-Tinkew, Burkhauser, & Metz, 2012). Embora recentemente algumas intervenções para pais (homens) já tenham sido criadas, estas, no entanto, não contam com robustos procedimentos de avaliação do envolvimento paterno (Bronte-Tinkew et al, 2007;Lundahl, Tollefson, Risser, & Lovejoy, 2008;McAllister, Burgess, Kato, & Barker, 2012).…”

Infant/Early Childhood Mental Health and Collaborative Partnerships: Beyond the NICU

“…This is unfortunate, as attention to relationships is central to the work that we do with very young children and their families (Achenbach, Howell, Aoki, & Rauh, 1993); Boukydis, 2012;Fitzgerald, Weatherston, & Mann, 2011;Benzies, Magill-Evans, Hayden & Ballantyne 2013;Melnyk, Feinstein, Fairbanks, Schultz-Czarniak, Hust, et. al., 2006).…”

“…Several key categories of support for parents with babies in the NICU have been identified that are well aligned with I/ECMH practice. These include parent emotional support, parent education, and child development support (Benzies, Magill-Evans, Hayden & Ballantyne, 2013;Purdy, Craig, & Zeanah, 2015). I/ECMH interventions have been shown to result in changes in parent-child interactions, parental mental health status, and child behavior and physiological status in the population of newborn intensive care unit graduates.…”