An Early Collaborative Intervention Focusing on Parent-Infant Interaction in the Neonatal Period. A Descriptive Study of the Developmental Framework

Charlotte Sahlén Helmer, Ulrika Birberg Thornberg, Evalotte Mörelius, Charlotte Sahlén Helmer, Ulrika Birberg Thornberg, Evalotte Mörelius

Abstract

Moderate to late preterm infants are at risk of developing problems later in life. To support attachment and infants' development, high quality parent-infant interaction is important. Parent-infant interaction is known to improve through intervention programs but since no such intervention program is addressed directly to moderate to late preterm infants, a tailor-made intervention was developed. The aim was to describe the rationale, development, framework and practical provision of a new early collaborative intervention program. This study has a descriptive design and the intervention is described using the Template for Intervention Description and Replication. During an intervention-session, the preterm infant's cues are made visible to the parents as they perform an everyday care-taking procedure. Instant feedback is delivered to give the parents the opportunity to notice, interpret and respond to cues immediately. The infant's response to the parent's action is discussed in a dialogue to instantly guide parents´ awareness of the preterm infant's subtle cues. This study describes a new early collaborative intervention, developed to support interaction between parents and their moderate to late preterm infants starting in the neonatal intensive care unit. Clinical studies evaluating parental experiences as well as the effects of the early intervention are ongoing, ClinicalTrials.gov NCT02034617.

Keywords: behavior; caregivers; descriptive design; early intervention; family health; infant health; infant premature; intensive care neonatal; neonatal nursing; parents.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study, in the writing of the manuscript or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart of the EACIs and a description of the content during each session.

References

    1. Bowlby J. Attachment and Loss. Basic Books; New York, NY, USA: 1969.
    1. Ainsworth M.D.S. Infant-Mother Attachment. Am. Psychol. 1979;34:932–937. doi: 10.1037/0003-066X.34.10.932.
    1. Brazelton B., Als H., Tronick E., Lester B. The Brazelton Neonatal Behavioral Assessment Scale (BNBAS) J. Abnorm. Child Psychol. 1977;5:215–229. doi: 10.1007/bf00913693.
    1. Broberg A.G. A review of interventions in the parent-child relationship informed by attachment theory. Acta Paediatr. Int. J. Paediatr. 2000;89:37–42. doi: 10.1111/j.1651-2227.2000.tb03094.x.
    1. Cassidy J., Jones J.D., Shaver P.R. Contributions of attachment theory and research: A framework for future research, translation, and policy. Dev. Psychopathol. 2013;25 Pt 2:1415–1434. doi: 10.1017/S0954579413000692.
    1. Deans C.L. Maternal sensitivity, its relationship with child outcomes, and interventions that address it: A systematic literature review. Early Child Dev. Care. 2020;190:252–275. doi: 10.1080/03004430.2018.1465415.
    1. Pisoni C., Spairani S., Fauci F., Ariaudo G., Tzialla C., Tinelli C., Politi P., Balottin U., Stronati M., Orcesi S. Effect of maternal psychopathology on neurodevelopmental outcome and quality of the dyadic relationship in preterm infants: An explorative study. J. Matern.-Fetal Neonatal Med. 2020;33:103–112. doi: 10.1080/14767058.2018.1487935.
    1. Feldman R., Eidelman A.I. Neonatal state organization, neuromaturation, mother-infant interaction, and cognitive development in small-for-gestational-age premature infants. Pediatrics. 2006;118:e869–e878. doi: 10.1542/peds.2005-2040.
    1. Baum N., Weidberg Z., Osher Y., Kohelet D. No Longer Pregnant, Not Yet a Mother: Giving Birth Prematurely to a Very-Low-Birth-Weight Baby. Qual. Health Res. 2012;22:595–606. doi: 10.1177/1049732311422899.
    1. Flacking R., Lehtonen L., Thomson G., Axelin A., Ahlqvist S., Moran V.H., Ewald U., Dykes F., The SCENE Group Closeness and separation in neonatal intensive care. Acta Paediatr. 2012;101:1032–1037. doi: 10.1111/j.1651-2227.2012.02787.x.
    1. Jiang S.Y., Warre R., Qiu X.M., O’Brien K., Lee S.K. Parents as practitioners in preterm care. Early Hum. Dev. 2014;90:781–785. doi: 10.1016/j.earlhumdev.2014.08.019.
    1. Cheong J.L., Doyle L., Burnett A.C., Lee K.J., Walsh J.M., Potter C.R., Treyvaud K., Thompson D.K., Olsen J.E., Anderson P.J., et al. Association Between Moderate and Late Preterm Birth and Neurodevelopment and Social-Emotional Development at Age 2 Years. JAMA Pediatrics. 2017;171:e164805. doi: 10.1001/jamapediatrics.2016.4805.
    1. Yun Sung N., Ju Sun H., Jung Hye B., Eun Hee L. Neurodevelopmental Outcomes of Moderate-to-Late Preterm Infants. Neonatal Med. 2020;27:159–166. doi: 10.5385/nm.2020.27.4.159.
    1. Flores C.T., Gerstein A., Phibbs C.S., Sanders L.M. Short-term and long-term educational outcomes of infants born moderatwly and late preterm. J. Pediatrics. 2020;232:31–37. doi: 10.1016/j.jpeds.2020.12.070.
    1. Thunqvist P., Gustafsson P.M., Schultz E.S., Bellander T., Berggren-Broström E., Norman M., Wickman M., Melén E., Hallberg J. Lung Function at 8 and 16 Years After Moderate-to-Late Preterm Birth: A Prospective Cohort Study. Pediatrics. 2016;137 doi: 10.1542/peds.2015-2056.
    1. WHO Preterm Birth 2018. [(accessed on 30 March 2021)]; Available online: .
    1. NVSS Births U.S. Department of Health and Human Services: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. [(accessed on 7 January 2021)];2019 Available online: .
    1. Socialstyrelsen Statistikdatabas för Graviditeter, Förlossningar och Nyfödda. [(accessed on 21 January 2021)];2020 Available online: .
    1. Yamamoto S., Premji S. The role of body, mind, and environment in preterm birth: Mind the gap. J. Midwifery Women’s Health. 2017;62:696–705. doi: 10.1111/jmwh.12658.
    1. Karnati S., Kollikonda S., Abu-Shaweesh J. Late preterm infants—Changing trends and continuing challenges. Int. J. Pediatrics Adolesc. Med. 2020;7:38–46. doi: 10.1016/j.ijpam.2020.02.006.
    1. Van Hus J.W.P., Jeukens-Visser M., Koldewijn K., Holman R., Kok J.H., Nollet F., Van Wassenaer-Leemhuis A.G. Early intervention leads to long-term developmental improvements in very preterm infants, especially infants with bronchopulmonary dysplasia. Acta Paediatr. 2016;105:773–781. doi: 10.1111/apa.13387.
    1. Jarjour I.T. Neurodevelopmental Outcome After Extreme Prematurity: A Review of the Literature. Pediatric Neurol. 2015;52:143–152. doi: 10.1016/j.pediatrneurol.2014.10.027.
    1. Nordhov M.S., Rønning J.A., Dahl L.B., Ulvund S.E., Tunby J., Kaaresen P.I. Early intervention improves cognitive outcomes for preterm infants: Randomized controlled trial. Pediatrics. 2010;126:e1088–e1094. doi: 10.1542/peds.2010-0778.
    1. Shuby P., Muhammad C., Pei-Ching T., Lesley K., Jogesh K. Effectiveness of early intervention programs for parents of preterm infants: A meta-review of systematic reviews. BMC Pediatrics. 2018;18:223. doi: 10.1186/s12887-018-1205-9.
    1. Evans T., Whittingham K., Sanders M., Colditz P., Boyd R.N. Are parenting interventions effective in improving the relationship between mothers and their preterm infants? Infant Behav. Dev. 2014;37:131–154. doi: 10.1016/j.infbeh.2013.12.009.
    1. Barlow J., Herath N.I., Bartram Torrance C., Bennett C., Wei Y. The Neonatal Behavioral Assessment Scale (NBAS) and Newborn Behavioral Observations (NBO) system for supporting caregivers and improving outcomes in caregivers and their infants. Cochrane Database Syst. Rev. 2018;3 doi: 10.1002/14651858.CD011754.pub2.
    1. Ravn I.H., Smith L., Lindemann R., Smeby N.A., Kyno N.M., Bunch E.H., Sandvik L. Effect of early intervention on social interaction between mothers and preterm infants at 12 months of age: A randomized controlled trial. Infant Behav. Dev. 2011;34:215–225. doi: 10.1016/j.infbeh.2010.11.004.
    1. Rauh V.A., Nurcombe B., Achenbach T., Howell C. The Mother-Infant Transaction Program: The Content and Implications of an Intervention for the Mothers of Low-Birthweight Infants. Clin. Perinatol. 1990;17:31–45. doi: 10.1016/S0095-5108(18)30586-4.
    1. Kynø N.M., Ravn I.H., Lindemann R., Fagerland M.W., Smeby N.A., Torgersen A.M. Effect of an early intervention programme on development of moderate and late preterm infants at 36 months: A randomized controlled study. Infant Behav. Dev. 2012;35:916–926. doi: 10.1016/j.infbeh.2012.09.004.
    1. Spittle A., Orton J., Anderson P.J., Boyd R., Doyle L.W. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst. Rev. 2015 doi: 10.1002/14651858.CD005495.pub4.
    1. Treyvaud K., Spittle A., Anderson P.J., O’Brien K. A multilayered approach is needed in the NICU to support parents after the preterm birth of their infant. Early Hum. Dev. 2019;139:104838. doi: 10.1016/j.earlhumdev.2019.104838.
    1. Heo Y.J., Oh W.-O. The effectiveness of a parent participation improvement program for parents on partnership, attachment infant growth in a neonatal intensive care unit: A randomized controlled trial. Int. J. Nurs. Stud. 2019;95:19–27. doi: 10.1016/j.ijnurstu.2019.03.018.
    1. Hoffmann T.C., Glasziou P.P., Boutron I., Milne R., Perera R., Moher D., Altman D.G., Barbour V., Macdonald H., Johnston M., et al. Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. BMJ Clin. Res. 2014;348:g1687. doi: 10.1136/bmj.g1687.
    1. Als H. A synactive model of neonatal behavioral organization: Framework for the assessment of neurobehavioral development in the premature infant and for support of infants and parents in the neonatal intensive care environment. Phys. Occup. Ther. Pediatrics. 1986;6:3–53. doi: 10.1080/J006v06n03_02.
    1. Craig J.W., Glick C., Phillips R., Hall S.L., Smith J., Browne J. Recommendations for involving the family in developmental care of the NICU baby. J. Perinatol. 2015;35:5–8. doi: 10.1038/jp.2015.142.
    1. Biringen Z., Robinson J. Emotional Availability in Mother-Child Interactions: A Reconceptualization for Research. Am. J. Orthopsychiatry. 1991;61:258–271. doi: 10.1037/h0079238.
    1. Mörelius E., Olsson E., Sahlén Helmer C., Thernström Blomqvist Y., Angelhoff C. External barriers for including parents of preterm infants in a randomised clinical trial in the neonatal intensive care unit in Sweden: A descriptive study. BMJ Open. 2020;10:e040991. doi: 10.1136/bmjopen-2020-040991.
    1. Suttora C., Spinelli M., Aureli T., Fasolo M., Lionetti F., Picciolini O., Ravasi M., Salerni N. Mind-Mindedness and Parenting Stress: A Cross-Sectional Study in a Cohort of Mothers of 3-Month-Old Full-Term and Preterm Infants. Int. J. Environ. Res. Public Health. 2020;17:7735. doi: 10.3390/ijerph17217735.
    1. Ionio C., Mascheroni E., Colombo C., Castoldi F., Lista G. Stress and feelings in mothers and fathers in NICU: Identifying risk factors for early interventions. Prim. Health Care Res. Dev. 2019;20:e81. doi: 10.1017/S1463423619000021.
    1. McMahon G.E., Spencer-Smith M.M., Pace C.C., Spittle A.J., Stedall P., Richardson K., Cheong J.L., Doyle L.W., Anderson P.J., Treyvaud K. Influence of Fathers’ Early Parenting on the Development of Children Born Very Preterm and Full Term. J. Pediatrics. 2019;205:195–201. doi: 10.1016/j.jpeds.2018.09.073.
    1. Holditch-Davis D., Schwartz T., Black B., Scher M. Correlates of mother-premature infant interactions. Res. Nurs. Health. 2007;30:333–346. doi: 10.1002/nur.20190.
    1. Ionio C., Lista G., Mascheroni E., Olivari M.G., Confalonieri E., Mastrangelo M., Brazzoduro V., Balestriero M.A., Banfi A., Bonanomi A., et al. Premature birth: Complexities and difficulties in building the mother–child relationship. J. Reprod. Infant Psychol. 2017;35:509–523. doi: 10.1080/02646838.2017.1383977.
    1. Mörelius E., Örtenstrand A., Theodorsson E., Frostell A. A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Hum. Dev. 2015;91:63–70. doi: 10.1016/j.earlhumdev.2014.12.005.
    1. Griffiths N., Spence K., Loughran-Fowlds A., Westrup B. Individualised developmental care for babies and parents in the NICU: Evidence-based best practice guideline recommendations. Early Hum. Dev. 2019;139:104840. doi: 10.1016/j.earlhumdev.2019.104840.
    1. Lavallée A., De Clifford-Faugère G., Ballard A., Aita M. Parent–Infant Interventions to Promote Parental Sensitivity During NICU Hospitalization: Systematic Review and Meta-Analysis. J. Early Interv. 2021:105381512199192. doi: 10.1177/1053815121991928.
    1. Premji S.S., Pana G., Currie G., Dosani A., Reilly S., Young M., Hall M., Williamson T., Lodha A.K. Mother’s level of confidence in caring for her late preterm infant: A mixed methods study. J. Clin. Nurs. 2018;27:E1120–E1133. doi: 10.1111/jocn.14190.
    1. Wigert H., Blom M.D., Bry K. Parents’ experiences of communication with neonatal intensive-care unit staff: An interview study. BMC Pediatrics. 2014;14:304. doi: 10.1186/s12887-014-0304-5.
    1. Guillaume S., Michelin N., Amrani E., Benier B., Durrmeyer X., Lescure S., Bony C., Danan C., Baud O., Jarreau P.-H., et al. Parents’ expectations of staff in the early bonding process with their premature babies in the intensive care setting: A qualitative multicenter study with 60 parents. BMC Pediatrics. 2013;13:18. doi: 10.1186/1471-2431-13-18.
    1. Martínez-Nadal S., Bosch L. Cognitive and Learning Outcomes in Late Preterm Infants at School Age: A Systematic Review. Int. J. Environ. Res. Public Health. 2020;18:74. doi: 10.3390/ijerph18010074.
    1. Ferreira R.D.C., Alves C.R.L., Guimarães M.A.P., De Menezes K.K.P., Magalhães L.D.C. Effects of early interventions focused on the family in the development of children born preterm and/or at social risk: A meta-analysis. J. Pediatr. 2020;96:20–38. doi: 10.1016/j.jped.2019.05.002.
    1. Manuck T.A., Rice M.M., Bailit J.L., Grobman W.A., Reddy U.M., Wapner R., Thorp J.M., Caritis S.N., Prasad M., Tita A., et al. Preterm neonatal morbidity and mortality by gestational age: A contemporary cohort. Am. J. Obstet. Gynecol. 2016;215:103.e1–103.e14. doi: 10.1016/j.ajog.2016.01.004.
    1. Amin L., Arina N., Tam W.W.S., Shorey S. Enhancing first-time parents’ self-efficacy: A systematic review and meta-analysis of universal parent education interventions’ efficacy. Int. J. Nurs. Stud. 2018;82:149–162. doi: 10.1016/j.ijnurstu.2018.03.021.
    1. Ainsworth M.D.S. Ainsworth Maternal Sensitivity Scales 1969. [(accessed on 12 May 2020)]; Available online: .
    1. Biringen Z., Closson L., Derscheid D., Vliegen N., Easterbrooks M.A. Emotional availability (EA): Theoretical background, empirical research using the EA Scales, and clinical applications. Dev. Rev. 2014;34:114–167. doi: 10.1016/j.dr.2014.01.002.
    1. Bayley N. Bayley Scales of Infant and Toddler Development. 3rd ed. Psychological Corporation; New York, NY, USA: 2006.
    1. Wechsler D. WPPSI-IV: Wechsler Preschool and Primary Scale of Intelligence—Fourth Edition. Pearson Education; New York, NY, USA: 2014.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir