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Key components of early intervention programs for preterm infants and their parents: a systematic review and
Karen M Benzies1, Joyce E Magill-Evans, K Alix Hayden
1Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada. benzies@ucalgary.ca
Insights
Early interventions positively impact maternal anxiety, depression, and self-efficacy in mothers of preterm infants. Psychosocial support is key for improving maternal well-being and infant development.
Area of Science:
- Neonatal care
- Developmental psychology
- Maternal mental health
Background:
- Preterm infants face higher risks of neurodevelopmental disabilities.
- Early interventions supporting parents can enhance infant environments and outcomes.
- Many interventions lack measurement of parental change or clear links to parental outcomes.
Purpose of the Study:
- To categorize early intervention components for preterm infants.
- To determine the effects of these components on parents and infants.
- To identify which intervention elements improve parental outcomes.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) from 1990-2011.
- Searched MEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Library.
- Included 18 RCTs with community components, focusing on 11 reporting maternal outcomes.
Main Results:
- Interventions included psychosocial support, parent education, and developmental therapies.
- Meta-analyses showed limited effects on maternal stress and infant sensitivity.
- Positive effects were found for maternal anxiety, depressive symptoms, and self-efficacy.
Conclusions:
- Early interventions show clinically meaningful psychosocial benefits for mothers of preterm infants.
- Heterogeneity in outcome measures and reporting limits definitive conclusions.
- Future interventions should integrate psychosocial support and measure outcomes for both mothers and infants.
Background:
Preterm 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.
Methods:
MEDLINE, 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.
Results:
Interventions 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).
Conclusions:
Positive 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 FINDINGS: Interventions 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.
