Reducing Premature Infants' Length of Stay and Improving Parents' Mental Health Outcomes With the Creating Opportunities for Parent Empowerment (COPE) Neonatal Intensive Care Unit Program: A Randomized, Controlled Trial

American Academy of Pediatrics (AAP) - Tập 118 Số 5 - Trang e1414-e1427 - 2006
Bernadette Mazurek Melnyk1, Nancy Fischbeck Feinstein2, Linda J. Alpert‐Gillis3, Eileen Fairbanks2, Hugh F. Crean4,5, Robert A. Sinkin6, Patricia W. Stone7, Leigh Small1, Xin Tu8,9, Steven Jay Gross10
1College of Nursing & Healthcare Innovation, Arizona State University, Phoenix, Arizona;
2School of Nursing
3Departments of Child and Adolescent Psychiatry
4Clinical and Social Psychology
5Clinical and Social Psychology; School of Nursing
6Pediatrics-Neonatology
7School of Nursing, Columbia University, New York, New York
8Biostatistics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
9Biostatistics, School of Medicine and Dentistry, University of Rochester, Rochester, New York; School of Nursing
10Department of Pediatrics-Neonatology, Crouse Hospital, Syracuse, New York

Tóm tắt

OBJECTIVE. Although low birth weight premature infants and parents are at high risk for adverse health outcomes, there is a paucity of studies that test early NICU interventions with parents to prevent the development of negative parent-infant interaction trajectories and to reduce hospital length of stay. Our objective was to evaluate the efficacy of an educational-behavioral intervention program (ie, Creating Opportunities for Parent Empowerment) that was designed to enhance parent-infant interactions and parent mental health outcomes for the ultimate purpose of improving child developmental and behavior outcomes.DESIGN, SETTING, AND PARTICIPANTS. A randomized, controlled trial was conducted with 260 families with preterm infants from 2001 to 2004 in 2 NICUs in the northeast United States. Parents completed self-administered instruments during hospitalization, within 7 days after infant discharge, and at 2 months' corrected age. Blinded observers rated parent-infant interactions in the NICU.INTERVENTION. All participants received 4 intervention sessions of audiotaped and written materials. Parents in the Creating Opportunities for Parent Empowerment program received information and behavioral activities about the appearance and behavioral characteristics of preterm infants and how best to parent them. The comparison intervention contained information regarding hospital services and policies.MAIN OUTCOME MEASURES. Parental stress, depression, anxiety, and beliefs; parent-infant interaction during the NICU stay; NICU length of stay; and total hospitalization were measured.RESULTS. Mothers in the Creating Opportunities for Parent Empowerment program reported significantly less stress in the NICU and less depression and anxiety at 2 months' corrected infant age than did comparison mothers. Blinded observers rated mothers and fathers in the Creating Opportunities for Parent Empowerment program as more positive in interactions with their infants. Mothers and fathers also reported stronger beliefs about their parental role and what behaviors and characteristics to expect of their infants during hospitalization. Infants in the Creating Opportunities for Parent Empowerment program had a 3.8-day shorter NICU length of stay (mean: 31.86 vs 35.63 days) and 3.9-day shorter total hospital length of stay (mean: 35.29 vs 39.19 days) than did comparison infants.CONCLUSIONS. A reproducible educational-behavioral intervention program for parents that commences early in the NICU can improve parent mental health outcomes, enhance parent-infant interaction, and reduce hospital length of stay.

Từ khóa


Tài liệu tham khảo

Hamilton BE, Martin JA, Sutton PD; Centers for Disease Control and Prevention, National Center for Health Statistics. Births: preliminary data for 2003. Natl Vital Stat Rep. 2004;53(9):1–17

Schraeder BD, Heverly MA, O'Brien C, Goodman R. Academic achievement and educational resource use of very low birth weight (VLBW) survivors. Pediatr Nurs. 1997;23:21–25, 44

Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA. 2002;288:2542–2543

McGrath M, Sullivan M. Birth weight, neonatal morbidities, and school age outcomes in full-term and preterm infants. Issues Compr Pediatr Nurs. 2002;25:231–254

O'Brien F, Roth S, Stewart A, Rifkin L, Rushe T, Wyatt J. The neurodevelopmental progress of infants less than 33 weeks into adolescence. Arch Dis Child. 2004;89:207–211

Reiss AL, Kesler SR, Vohr B, et al. Sex differences in cerebral volumes of 8-year-olds born preterm. J Pediatr. 2004;145:242–249

Saigal S, Ouden LD, Wolke D, et al. School-age outcomes in children who were extremely low birth weight from four international population-based cohorts. Pediatrics. 2003;112:943–950

Gross SJ, Mettelman BB, Dye TD, Slagle TA. Impact of family structure and stability on academic outcome in preterm children at 10 years of age. J Pediatr. 2001;138:153–156

Altimier L, Eichel M, Warner B, Tedeschi L, Brown B. Developmental care: changing the NICU physically and behaviorally to promote patient outcomes and costs. Neonatal Intensive Care. 2004;17:35–39

Leijon I, Finnstrom O, Sydsjo G, Wadsby M. Use of healthcare resources, family function, and socioeconomic support during the first four years after preterm birth. Arch Dis Child Fetal Neonatal Ed. 2003;88:F415–F420

Petrou S, Mehta Z, Hockley C, et al. The impact of preterm birth on hospital inpatient admissions and costs during the first 5 years of life. Pediatrics. 2003;112:1290–1297

Rogowski J. Using economic information in a quality improvement collaborative. Pediatrics. 2003;111(4). Available at: www.pediatrics.org/cgi/content/full/111/4/SE1/e411

Cusson RM. Factors influencing language development in preterm infants. J Obstet Gynecol Neonatal Nurs. 2003;32:402–409

Melnyk BM, Alpert-Gillis L, Feinstein NF, et al. Improving cognitive development of low-birth-weight premature infants with the COPE program: a pilot study of the benefit of early NICU intervention with mothers. Res Nurs Health. 2001;24:373–389

Pinelli J. Effects of family coping and resources on family adjustment and parental stress in the acute phase of the NICU experience. Neonatal Netw. 2002;19(6):27–37

Miles MS, D'Auria J. Parenting the medically fragile infant. Capsules Comments Pediatr Nurs. 1994;1:2–14

Miles MS, Holditch-Davis D, Burchinal P, Nelson D. Distress and growth outcomes in mothers of medically fragile infants. Nurs Res. 1999;48:129–140

Singer LT, Salvator A, Guo S, Collin M, Lilien L, Baley J. Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA. 1999;281:799–805

Wereszczak J, Miles MS, Holditch-Davis D. Maternal recall of the neonatal intensive care unit. Neonatal Netw. 1997;16(4):33–40

Melnyk BM, Feinstein NF, Fairbanks E. Effectiveness of informational/behavioral interventions with parents of low birth weight (LBW) premature infants: an evidence base to guide clinical practice. Pediatr Nurs. 2002;28:511–516

Berlin LJ, Brooks-Gunn J, McCarton C, McCormick MC. The effectiveness of early intervention: examining risk factors and pathways to enhanced development. Prev Med. 1998;27:238–245

Minde K. Prematurity and serious medical conditions in infancy: implications for development, behavior, and intervention. In: Zeanah CH Jr, ed. Handbook of Infant Mental Health. 2nd ed. New York, NY: Guilford Press; 2000:176–194

Leventhal H, Johnson JE. Laboratory and field experimentation: development of a theory of self-regulation. In: Woolridge PJ, Schmitt MH, Skipper JK Jr, Leonard RC, eds. Behavioral Science and Nursing Theory. St Louis, MO: Mosby; 1983:189–262

Johnson JE, Fieler VK, Jones LS, Wlasowicz GS, Mitchell ML. Self-Regulation Theory: Applying Theory to Your Practice. Pittsburgh, PA: Oncology Nursing Press; 1997

Carver CS, Scheier MF. Comparison theory: a useful conceptual framework for personality-social, clinical, and health psychology. Psychol Bull. 1982;92:111–135

Lorion RP, Price RH, Eaton WW. The prevention of child and adolescent disorders: from theory to research. In: Schaffer D, Phillips S, Enzer NB, eds. Prevention of Mental Disorders, Alcohol and Other Drug Use in Children and Adolescents. Rockville, MD: US Office of Substance Abuse Prevention; 1989:55–96. DHHS publication No. ADM 89-1646

Spielberger C, Gorsuch R, Lushene R. The STAI Manual. Palo Alto, CA: Consulting Psychologists; 1977

Beck AT, Steer RA, Brown GK. Beck Depression Inventory: 2nd ed. Manual. San Antonio, TX: Psychological Corporation: 1996

Miles MS. Parents of critically ill premature infants: sources of stress. Crit Care Nurs Q. 1989;12(3):69–74

Melnyk B, Feinstein NF, Fairbanks E, Small L. The Index of Parental Behavior in the NICU. Rochester, NY: University of Rochester; 1998

Melnyk BM. The Parental Belief Scale: NICU. Rochester, NY: University of Rochester; 1997

Richarchson DK, Tarnow-Mordi WO, Escobar GJ. Neonatal risk systems: can they predict mortality and morbidity?Clin Perinatol. 1988;25:591–611

Cohen J. A power primer. Psychol Bull. 1992;112:155–159

Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomized controlled trials. BMJ. 1999;319:670–674

DiCenso A, Guyatt G. The principle of intention to treat. In: DiCenso A, Guyatt G, Ciliska D, eds. Evidence-Based Nursing: A Guide to Clinical Practice. St Louis, MO: Elsevier Mosby; 2005:245–250

Melnyk BM. Coping with unplanned childhood hospitalization: effects of informational interventions on mothers and children. Nurs Res. 1994;43:50–55

Melnyk BM. Coping with unplanned childhood hospitalization: the mediating functions of parental beliefs. J Pediatr Psychol. 1995;20:299–312

Melnyk BM, Alpert-Gillis LJ, Hensel PB, Cable-Beiling RC, Rubenstein JS. Helping mothers cope with a critically ill child: a pilot test of the COPE intervention. Res Nurs Health. 1997;20:3–14

Melnyk BM, Alpert-Gillis L, Feinstein NF, et al. Creating Opportunities for Parent Empowerment: program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics. 2004;113(6). Available at: www.pediatrics.org/cgi/content/full/113/6/e597

Oehler JM, Hannan T, Catlett A. Maternal views of preterm infants' responsiveness to social interaction. Neonatal Netw. 1993;12:67–74

Beck CT. The effects of postpartum depression on maternal-infant interaction: a meta-analysis. Nurs Res. 1995;44:298–304

Beck CT, Gable RK. Postpartum Depression Screening Scale: development and psychometric testing. Nurs Res. 2001;49:272–282

Georgiopoulos A, Bryan T, Wollan P, Yawn B. Routine screening for postpartum depression [published correction appears in J Fam Pract. 2001;50:470]. J Fam Pract. 2001;50:117–125

O'Hara MW, Stuart S, Gorman LL, Wenzel A. Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry. 2000;57:1039–1045

Zlotnick C, Johnson S, Miller I, Pearlstein T, Howard M. Postpartum depression in women receiving public assistance: pilot study of an interpersonal-therapy-oriented group intervention. Am J Psychiatry. 2001;158:638–640

Ugarrizza DN. The assessment and treatment of post-partum depression. In: Melnyk BM, Fineout-Overholt E, eds. Evidence-Based Practice in Nursing and Healthcare. Philadelphia, PA: Lippincott, Williams & Wilkins; 2004:19–26

Halpern LF, McClean WE Jr. “Hey mom, look at me!” Infant Behav Dev. 1997;20:515–529

Gennaro S, Brooten D, Roncoli M, Kumar SP. Stress and health outcomes among mothers of low-birth-weight infants. West J Nurs Res. 1993;15:97–113

McCarton CM, Brooks-Gunn J, Wallace IF, et al. Results at age 8 years of early intervention for low-birth-weight premature infants. The Infant Health and Development Program. JAMA. 1997;277:126–132

Holditch-Davis D, Roberts D, Sandelowski M. Early parenting interactions with and perceptions of multiple births. J Adv Nurs. 1999;30:200–210

Oliveness F, Golombok S, Ramogida C, Rust J, et al; Follow-up Team. Behavioral and cognitive development as well as family functioning of twins conceived by assisted reproduction: findings from a large population study. Fertil Steril. 2005;84:725–733

Ramey CT, Ramey SL. Prevention of intellectual disabilities: early interventions to improve cognitive development. Prev Med. 1998;27:224–232