The Cues and Care Randomized Controlled Trial of a Neonatal Intensive Care Unit Intervention: Effects on Maternal Psychological Distress and Mother-Infant Interaction

Zelkowitz, Phyllis; Feeley, Nancy; Shrier, Ian; Stremler, Robyn; Westreich, Ruta; Dunkley, David M.; Steele, Russell; Rosberger, Zeev; Lefebvre, Françine; Papageorgiou, Apostolos

doi:10.1097/dbp.0b013e318227b3dc

Cited by 47 publications

(156 citation statements)

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“…were unable to demonstrate any significant changes in parent or infant outcomes [22]. A recent study of a skill-based program called “cues” was also unable to demonstrate any additional benefit over non-specific education [23]. However, in a randomised controlled trial, Melnyk et al , demonstrated that the COPE program, which focuses on providing parents with a very structured educational-behavioural program, improves parent coping and mental health outcomes during and after hospitalization, as well as shortening infants’ length of stay [6].…”

Section: Discussionmentioning

confidence: 99%

A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit

O’Brien

Bracht

Macdonell

et al. 2013

BMC Pregnancy Childbirth

249

229

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BackgroundWe have developed a Family Integrated Care (FIC) model for use in a neonatal intensive care unit (NICU) where parents provide most of the care for their infant, while nurses teach and counsel parents. The objective of this pilot prospective cohort analytic study was to explore the feasibility, safety, and potential outcomes of implementing this model in a Canadian NICU.MethodsInfants born ≤35 weeks gestation, receiving continuous positive airway pressure or less respiratory support, with a primary caregiver willing and able to spend ≥8 hours a day with their infant were eligible. Families attended daily education sessions and were mentored at the bedside by nurses. The primary outcome was weight gain, as measured by change in z-score for weight 21 days after enrolment. For each enrolled infant, we identified two matched controls from the previous year’s clinical database. Differences in weight gain between the two groups were analyzed using a linear mixed effects multivariable regression model. We also measured parental stress levels using the Parental Stress Survey: NICU, and interviewed parents and nurses regarding their experiences with FIC.ResultsThis study included 42 mothers and their infants. Of the enrolled infants, matched control data were available for 31 who completed the study. The rate of change in weight gain was significantly higher in FIC infants compared with control infants (p < 0.05). There was also a significant increase in the incidence of breastfeeding at discharge (82.1 vs. 45.5%, p < 0.05). The mean Parental Stress Survey: NICU score for FIC mothers was 3.06 ± 0.12 at enrolment, which decreased significantly to 2.30 ± 0.13 at discharge (p < 0.05). Feedback from the parents and nurses indicated that FIC was feasible and appropriately implemented.ConclusionsThis study suggests that the FIC model is feasible and safe in a Canadian healthcare setting and results in improved weight gain among preterm infants. In addition, this innovation has the potential to improve other short and long-term infant and family outcomes. A multi-centre randomized controlled trial is needed to further evaluate the efficacy of FIC in the Canadian context.

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Section: Discussionmentioning

confidence: 99%

A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit

O’Brien

Bracht

Macdonell

et al. 2013

BMC Pregnancy Childbirth

249

229

View full text Add to dashboard Cite

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“…Most of the trials reported beneficial short and long-term infant and parent outcomes, including shorter hospital stay [55], better cognitive development [48,54,58,61], improved mother-infant interaction and attachment [49,56], reduced parenting stress [54][55][56], less maternal depression and anxiety [55,58], improved maternal confidence in parenting [55,58], better maternal sensitivity/ responsiveness [60], and higher maternal self-efficacy [61]. Two studies of a parent education program failed to find any effect on infant development, maternal stress/anxiety, or maternal-infant interaction [51,63]. However, the emphasis in these family-centred care programs has been to increase parent knowledge and confidence, but not to fully engage parents in all aspects of their infant's care.…”

Section: Previous Studiesmentioning

confidence: 99%

“…Over the past 25 years several family-centred care programs have been developed and subjected to randomized controlled trials [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]. These programs use one or more approaches, such as parent education, provision of psychological support, teaching developmental care, and facilitating better communication, to address a variety of domains including parent-infant interaction, parental knowledge and confidence, and parental stress.…”

Section: Previous Studiesmentioning

confidence: 99%

Parents as practitioners in preterm care

Jiang

Warre

Qiu

et al. 2014

Early Human Development

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“…El 55 % de los estudios proporcionaron los tres componentes educativos de la intervención (44,45,47,50,52); el 33 % utilizó solo la información (42, 46, 51) y el 22 % no proporcionó apoyo emocional parental (42,46). Los nueve estudios incluidos informaron resultados paternos de estrés.…”

Section: Componentes De La Intervenciónunclassified

Metaanálisis: efecto de las intervenciones para disminuir el nivel de estrés en padres de prematuros

2016

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RESUMENIntroducción: el nacimiento prematuro de un bebé genera estrés en los padres, por el riesgo de aumento en la morbimortalidad que esto conlleva. Existen intervenciones que disminuyen el nivel de estrés en los padres beneficiando a su vez el neurodesarrollo del recién nacido. Objetivo: categorizar los principales componentes de los programas de intervención temprana y determinar el efecto de estas intervenciones en la disminución del nivel de estrés en padres de prematuros hospitalizados. Método: metaanálisis con 9 ensayos clínicos controlados, que cumplieron los criterios de rigurosidad metodológica. Resultados: las intervenciones aplicadas a los padres de prematuros hospitalizados mostraron efecto de intensidad media-baja sobre el nivel de estrés percibido (d=0,36 IC [-0.68, -0,05]). Sin embargo, las pruebas de heterogeneidad indican alta variabilidad inter-estudio (Q(df=8) = p-val: <0,00001), I2=85% ), explicada parcialmente por las características moderadoras codificadas para los estudios. Conclusiones: aunque las intervenciones mostraron efectos positivos en la disminución del nivel de estrés en los padres, se evidencia que la educación y el apoyo emocional en conjunto logran un mejor efecto. Las futuras investigaciones deben analizar aspectos como calidad de los estudios, intervenciones con apoyo emocional, edad de los padres y diversidad en los contextos de aplicación. PALABRAS CLAVEPadres; prematuro; estrés psicológico; intervención; metaanálisis; instrumentos; enfermería Neonatal (Fuente: DeCS, BIREME). The preterm birth of a baby stresses the parents, due to the risk of increased morbidity and mortality. Some interventions decrease parental stress levels while benefiting the neurodevelopment of the newborn. Objective: To categorize the main components of early intervention programs and to determine their effect in decreasing the stress levels of parents of hospitalized premature babies. Method: Meta-analysis with 9 controlled clinical trials that met the criteria of methodological rigor. Results: The interventions applied to parents of hospitalized premature babies showed a medium-low intensity effect on the perceived stress level (d=0.36 IC [-0.68, -0.05]). However, heterogeneity tests indicate high inter-study variability (Q(df=8) = p-val: <0.00001), I2=85% ), partially explained by the moderating coded features for the studies. Conclusions: Even though the interventions revealed positive effects in reducing parental stress levels, it is shown that education and emotional support achieve a better effect together. Future research should examine aspects such as the quality of studies, interventions with emotional support, parental age and diversity in application contexts.

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The Cues and Care Randomized Controlled Trial of a Neonatal Intensive Care Unit Intervention: Effects on Maternal Psychological Distress and Mother-Infant Interaction

Abstract: Nonspecific attention was as effective as an early skill-based intervention in reducing maternal anxiety and enhancing sensitive behavior in mothers of VLBW infants.

Cited by 47 publications

References 54 publications

A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit

A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit

Parents as practitioners in preterm care

Metaanálisis: efecto de las intervenciones para disminuir el nivel de estrés en padres de prematuros

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