Effectiveness of early intervention programs for parents of preterm infants: a meta-review of systematic reviews

Background: Various intervention programs exist for parents of preterm babies and some systematic reviews (SRs) have synthesised the evidence of their effectiveness. These reviews are, however, limited to specific interventions, components, or outcomes, and a comprehensive evidence base is lacking. The aim of this meta-review was to appraise and meta-synthesise the evidence from existing SRs to provide a comprehensive evidence base on the effectiveness of interventions for parents of preterm infants on parental and infant outcomes. Methods: We conducted a comprehensive search of the following databases to identify relevant SRs: Cochrane library, Web of science, EMBASE, CINAHL, British Nursing Index, PsycINFO, Medline, ScienceDirect, Scopus, IBSS, DOAJ, ERIC, EPPI-Centre, PROSPERO, WHO Library. Additional searches were conducted using authors’ institutional libraries, Google Scholar, and the reference lists of identified reviews. Identified articles were screened in two stages against an inclusion criteria with titles and abstracts screened first followed by full-text screening. Selected SRs were appraised using the AMSTAR tool. Extracted data using a predesigned tool were synthesised narratively examining the direction of impact on outcomes. Results: We found 11 SRs eligible for inclusion that synthesised a total of 343 quantitative primary studies. The average quality of the SRs was ‘medium’. Thirty four interventions were reported across the SRs with considerable heterogeneity in the structural framework and the targeted outcomes that included maternal-infant dyadic, maternal/parental, and infant outcomes. Among all interventions, Kangaroo Care (KC) showed the most frequent positive impact across outcomes (n = 19) followed by Mother Infant Transaction Program (MITP) (n = 14). Other interventions with most consistent positive impact on infant outcomes were Modified-Mother Infant Transaction Program (M-MITP) (n = 6), Infant Health and Development Program (IHDP) (n = 5) and Creating Opportunities for Parent Empowerment (COPE) (n = 5). Overall, interventions with both home and facility based components showed the most frequent positive impact across outcomes. Conclusions: Neonatal care policy and planning for preterm babies should consider the implementation of interventions with most positive impact on outcomes. The heterogeneity in interventions and outcomes calls for the development and implementation of an integrated program for parents of preterm infants with a clearly defined global set of parental and infant outcomes

Mother-Very Preterm Infant Relationship Quality: RCT of Baby Triple P

This study examined intervention outcomes for mothers and their preterm infants. The objective was to evaluate the effects of the parenting intervention Baby Triple P (BTP) for parents’ of very preterm infants (<32-weeks gestational age), on the quality of the mother–infant relationship and a mother’s attachment and responsiveness to her infant at 6-weeks and 12-months corrected-age. A randomized controlled trial was conducted with 120 families being randomly assigned to the BTP or Care as Usual groups. The primary outcome was the quality of the mother-very preterm infant relationship which was evaluated in a mother-infant observation and measured by the Emotional Availability Scales. Secondary outcomes were maternal attachment as measured by the Maternal Postnatal Attachment Scale and maternal responsiveness as measured by the Maternal Infant Responsiveness Instrument. The results showed that at 6-weeks corrected-age, no significant differences were found between groups on the outcome measures. At 12-months corrected-age, the Care as Usual mothers scored significantly higher for self-reported maternal attachment compared to the BTP mothers. This study found no evidence that BTP improved the quality of the mother-very preterm infant relationship, maternal attachment or responsiveness at 6-weeks corrected-age or 12-months corrected-age. Results will be examined at 24-months corrected-age to determine if BTP impacts on child behavior, emotional problems, cognitive development, language and motor abilities