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Feasibility of a guided participation discharge program for very preterm infants in a neonatal intensive care unit: a
S Y Lee1, J P C Chau2, K C Choi3
1Department of Pediatrics, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong SAR.
Insights
A nurse-led guided participation (GP) discharge program showed potential benefits for mothers of very preterm infants, improving parenting competence and reducing stress. This intervention appears feasible for neonatal intensive care unit (NICU) settings.
Area of Science:
- Neonatal care
- Parental mental health
- Evidence-based interventions
Background:
- Parents of very preterm infants often experience feelings of incompetence and high stress.
- Previous systematic reviews suggest guided participation (GP) discharge interventions may benefit parental outcomes.
- Further research is needed on effective GP intervention doses.
Purpose of the Study:
- To assess the feasibility of a novel nurse-led, GP discharge program for mothers of very preterm infants.
- To preliminarily evaluate the program's effects on maternal competence and stress.
Main Methods:
- A randomized controlled trial in a NICU involving 30 mothers of very preterm infants (gestational age ≤32 weeks).
- Intervention group received nurse-led GP discharge support (3 sessions + 1 phone call); control group received usual care.
- Parental outcomes measured using Parenting Sense of Competence Scale (C-PSOC) and Perceived Stress Scale (C-PSS) at multiple time points.
Main Results:
- The intervention group showed greater improvements in C-PSOC scores at discharge (T1) and post-call (T2) compared to the control group, though not statistically significant.
- The intervention group also demonstrated greater improvements in C-PSS scores at T1, T2, and 1-month post-discharge (T3), also without statistical significance.
- No adverse events were reported, indicating feasibility.
Conclusions:
- A GP discharge intervention shows promise for enhancing parenting competence and reducing stress in mothers of very preterm infants.
- The intervention is feasible for implementation in NICU settings.
- This study provides a foundation for a larger, powered trial to confirm effectiveness.
Background:
Previous studies showed that parents of very preterm infants expressed feelings of incompetence and experienced high levels of stress upon the discharge of their infants. We conducted a systematic review of seven studies and observed potential benefits for parental outcomes when using discharge interventions that adopted guided participation (GP). More evidence is needed on the effective doses of discharge interventions underpinned by the principles of GP.
Aim:
To investigate the feasibility and preliminarily estimate the effects on parental competence and stress outcomes of a newly developed, nurse-led, GP discharge program for mothers of very preterm infants.
Methods:
A two-arm randomized controlled trial was conducted in a neonatal intensive care unit (NICU). Mothers of infants with gestational ages of ≤32 weeks who had no congenital malformations and did not need to undergo major surgeries were recruited. All mothers were the primary caregivers to their infants. The intervention group received a nurse-led GP discharge intervention (three structured 30- to 60-min GP sessions and one follow-up phone call). The control group received usual care. The parental outcomes were measured using the Parenting Sense of Competence Scale (C-PSOC) and Perceived Stress Scale (C-PSS) at baseline (T0), on the day of discharge (T1), after the follow-up phone call (within 72 h after discharge) (T2), and 1 month after discharge (T3). The outcomes were analyzed using generalized estimating equations based on intention-to-treat principles.
Results:
Thirty infant-mother dyads were recruited. Greater improvements in the C-PSOC score were observed in the intervention group than in the control group at T1 and T2, although these differences were statistically insignificant. The intervention group exhibited greater improvements than the control group in the C-PSS scores at T1, T2, and T3, although these differences were also not statistically significant.
Conclusions:
The findings suggest that a GP discharge intervention could improve parenting competence and stress among mothers with very preterm infants. The absence of adverse events suggests that the GP discharge intervention could be feasibly implemented in NICU settings. This feasibility study was not powered to determine the effectiveness of the intervention but is anticipated to lay the foundation for a future full-scale study.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03668912. Date of registration: 13 September 2018 (retrospectively registered).
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