Behavioral Intervention With Maternal Participatory Guidance Improves Preterm Infant Outcomes

2.50
Hdl Handle:
http://hdl.handle.net/10755/622171
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Behavioral Intervention With Maternal Participatory Guidance Improves Preterm Infant Outcomes
Other Titles:
Maternal Education in Preterm Infants
Author(s):
White-Traut, Rosemary C.
Lead Author STTI Affiliation:
Alpha Lambda
Author Details:
Rosemary C. White-Traut, PhD, RN, FAAN, Professional Experience: Dr. White-Traut is Professor Emerita, and former department head at University of Illinois Chicago. She has mentored post graduate fellows, graduate students and undergraduate nursing students. She is currently the Director of Nursing Research at Children's Hospital of Wisconsin. Author Summary: Dr. White-Traut is Director of Nursing Research at the Children’s’ Hospital of Wisconsin and Professor Emerita at the University of Illinois at Chicago. Dr. White-Traut’s research evaluates outcomes to a mother-infant behavioral intervention. She has documented enhanced infant behavior, improved feeding, reduced length of hospital stay, reduced stress levels, improved maternal recognition of feeding cues, improved patterns of maternal-infant interaction, and reduced health care utilization and cost after infants received the intervention.
Abstract:
Purpose: This completed randomized controlled trial of 198 premature infants born at 29-34 weeks gestation and their mothers examined the impact of the H-HOPE (Hospital to Home: Optimizing the Preterm Infant’s Environment) intervention on infant behavior, infant feeding and growth during hospitalization, mother-infant interaction, and illness visits when the infants reached 6-weeks corrected age (CA). The research was guided by two models: Developmental Science and Adult Learning Theory.

Methods: Mother-infant dyads were randomly assigned to the H-HOPE intervention group or an Attention Control group. H-HOPE is an integrated intervention that included (1) twice-daily infant multisensory stimulation using the ATVV Intervention (auditory, tactile, visual, and vestibular-rocking stimulation) offered prior to feeding and (2) four maternal participatory guidance sessions by a nurse-community advocate team. Infant behavior was measured weekly during hospitalization via the proportion of alert states and the frequency of orally directed behaviors when infants were able to feed orally. Infant feeding was measured weekly during hospitalization by Medoff-Cooper’s nutritive sucking apparatus and growth was determined by daily weight gain and weekly length. Mother-infant interaction was assessed after hospital discharge at 6-weeks CA using Barnard’s Nursing Child Assessment Satellite Training–Feeding Scale (NCAST, 76 items) and Censullo’s Dyadic Mutuality Code (DMC, 6-item contingency scale during a 5-minute play session). Illness visits from hospital discharge through 6 weeks CA were reported by the mothers.

Results: There were no differences between the groups at baseline for any of the dependent variables. The infant behavior data showed that by day 7, the intervention group exhibited a significantly higher mean frequency of orally directed behaviors when compared with the Attention Control group (12.6 vs. 7.1 pre-intervention, < 0.10; 51.8 vs. 33.2 during intervention, < 0.10; and 8.9 vs. 5.3 immediately prior to feeding, < 0.05). Also on day 7, the H-HOPE intervention group exhibited a significantly higher proportion of time spent in an alert state during intervention (0.26 vs. 0.11, < 0.05) and immediately after intervention (0.28 vs. 0.06, < 0.01).

Infant feeding during hospitalization differed between the two groups. A quadratic trend was observed for infant feeding as measured by the number of sucks, the number of sucks per sucking burst, and a sucking maturity index. The intervention group experienced an increasing significantly improved oral feeding by day 7 (Model estimates for group by day: number of sucks - β = 13.69, p < 0.01; number of sucks per sucking burst - β = 1.16, < 0.01; and the sucking maturity index β = 0.12, < 0.05). Sucking pressure increased linearly over time, with significant between-group differences reached at day 14 (β = 45.66, p < 0.01). During hospital stay, the H-HOPE group infants gained weight more rapidly over time when compared with infants in the control group (p = 0.04) and grew in length (p = 0.015) more rapidly than control infants, especially during the latter part of the hospital stay.

After hospital discharge and when the infants reached 6-weeks CA, NCAST and DMC scores for the Control and H-HOPE groups were compared using t-tests, chi-square tests and multivariable analysis. Compared with the Control group (n = 76), the H-HOPE group (n = 66) trended toward higher NCAST scores overall and higher maternal Social-Emotional Growth Fostering Subscale scores and had significantly higher scores for the overall infant subscale and the Infant Clarity of Cues Subscale (p < 0.05). H-HOPE group dyads were also more likely to have high responsiveness during play as measured by the DMC (67.6% versus 58.1% of controls). After adjustment for significant maternal and infant characteristics, H-HOPE group dyads had marginally higher scores during feeding on overall mother-infant interaction (β = 2.03, p = .06) and significantly higher scores on the infant subscale (β = 0.75, p = .05) when compared to controls. Infants assigned to the H-HOPE group were also half as likely to have illness episodes (illness visit to the clinic, emergency department (ED) or hospital readmission) as control infants (OR = 0.46, 95% CI = 0.22, 0.95).

Conclusion:  Intervening with both mother and preterm infant during initial hospitalization and the first month following hospital discharge is a promising strategy to support infant behavior, oral feeding, and infant growth, improve mother-infant interaction, and reduce infant illnesses following hospital discharge.

Keywords:
development intervention; infant behavior and growth; preterm infant
Repository Posting Date:
25-Jul-2017
Date of Publication:
25-Jul-2017
Other Identifiers:
INRC17N10
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleBehavioral Intervention With Maternal Participatory Guidance Improves Preterm Infant Outcomesen_US
dc.title.alternativeMaternal Education in Preterm Infantsen
dc.contributor.authorWhite-Traut, Rosemary C.en
dc.contributor.departmentAlpha Lambdaen
dc.author.detailsRosemary C. White-Traut, PhD, RN, FAAN, Professional Experience: Dr. White-Traut is Professor Emerita, and former department head at University of Illinois Chicago. She has mentored post graduate fellows, graduate students and undergraduate nursing students. She is currently the Director of Nursing Research at Children's Hospital of Wisconsin. Author Summary: Dr. White-Traut is Director of Nursing Research at the Children’s’ Hospital of Wisconsin and Professor Emerita at the University of Illinois at Chicago. Dr. White-Traut’s research evaluates outcomes to a mother-infant behavioral intervention. She has documented enhanced infant behavior, improved feeding, reduced length of hospital stay, reduced stress levels, improved maternal recognition of feeding cues, improved patterns of maternal-infant interaction, and reduced health care utilization and cost after infants received the intervention.en
dc.identifier.urihttp://hdl.handle.net/10755/622171-
dc.description.abstract<div class="sectionbox"> <div class="section paperreviewdisplay paperdefaultdisplay reviewdisplay defaultdisplay"> <div class="columnwrapper"> <div class="displayinfo leftcolumn"> <div class="section"> <div class="item"><strong>Purpose: </strong>This completed randomized controlled trial of 198 premature infants born at 29-34 weeks gestation and their mothers examined the impact of the H-HOPE (Hospital to Home: Optimizing the Preterm Infant’s Environment) intervention on infant behavior, infant feeding and growth during hospitalization, mother-infant interaction, and illness visits when the infants reached 6-weeks corrected age (CA). The research was guided by two models: Developmental Science and Adult Learning Theory. <p><strong>Methods: </strong>Mother-infant dyads were randomly assigned to the H-HOPE intervention group or an Attention Control group. H-HOPE is an integrated intervention that included (1) twice-daily infant multisensory stimulation using the ATVV Intervention (auditory, tactile, visual, and vestibular-rocking stimulation) offered prior to feeding and (2) four maternal participatory guidance sessions by a nurse-community advocate team. Infant behavior was measured weekly during hospitalization via the proportion of alert states and the frequency of orally directed behaviors when infants were able to feed orally. Infant feeding was measured weekly during hospitalization by Medoff-Cooper’s nutritive sucking apparatus and growth was determined by daily weight gain and weekly length. Mother-infant interaction was assessed after hospital discharge at 6-weeks CA using Barnard’s Nursing Child Assessment Satellite Training–Feeding Scale (NCAST, 76 items) and Censullo’s Dyadic Mutuality Code (DMC, 6-item contingency scale during a 5-minute play session). Illness visits from hospital discharge through 6 weeks CA were reported by the mothers.</p> <p><strong>Results: </strong>There were no differences between the groups at baseline for any of the dependent variables. The infant behavior data showed that by day 7, the intervention group exhibited a significantly higher mean frequency of orally directed behaviors when compared with the Attention Control group (12.6 vs. 7.1 pre-intervention, <em>p </em>< 0.10; 51.8 vs. 33.2 during intervention, <em>p </em>< 0.10; and 8.9 vs. 5.3 immediately prior to feeding, <em>p </em>< 0.05). Also on day 7, the H-HOPE intervention group exhibited a significantly higher proportion of time spent in an alert state during intervention (0.26 vs. 0.11, <em>p </em>< 0.05) and immediately after intervention (0.28 vs. 0.06, <em>p </em>< 0.01).</p> <p>Infant feeding during hospitalization differed between the two groups. A quadratic trend was observed for infant feeding as measured by the number of sucks, the number of sucks per sucking burst, and a sucking maturity index. The intervention group experienced an increasing significantly improved oral feeding by day 7 (Model estimates for group by day: number of sucks<em> - β</em> = 13.69, <em>p</em> < 0.01; number of sucks per sucking burst<em> - β</em> = 1.16, <em>p </em>< 0.01; and the sucking maturity index <em>β</em> = 0.12, <em>p </em>< 0.05). Sucking pressure increased linearly over time, with significant between-group differences reached at day 14 (<em>β</em> = 45.66, <em>p</em> < 0.01). During hospital stay, the H-HOPE group infants gained weight more rapidly over time when compared with infants in the control group (<em>p</em> = 0.04) and grew in length (<em>p</em> = 0.015) more rapidly than control infants, especially during the latter part of the hospital stay.</p> <p>After hospital discharge and when the infants reached 6-weeks CA, NCAST and DMC scores for the Control and H-HOPE groups were compared using <em>t</em>-tests, chi-square tests and multivariable analysis. Compared with the Control group (<em>n =</em> 76), the H-HOPE group (<em>n = </em>66) trended toward higher NCAST scores overall and higher maternal Social-Emotional Growth Fostering Subscale scores and had significantly higher scores for the overall infant subscale and the Infant Clarity of Cues Subscale <em>(p </em>< 0.05). H-HOPE group dyads were also more likely to have high responsiveness during play as measured by the DMC (67.6% versus 58.1% of controls). After adjustment for significant maternal and infant characteristics, H-HOPE group dyads had marginally higher scores during feeding on overall mother-infant interaction (<em>β</em> = 2.03, <em>p</em> = .06) and significantly higher scores on the infant subscale (<em>β</em> = 0.75, <em>p</em> = .05) when compared to controls. Infants assigned to the H-HOPE group were also half as likely to have illness episodes (illness visit to the clinic, emergency department (ED) or hospital readmission) as control infants (OR = 0.46, 95% CI = 0.22, 0.95).</p> <p><strong>Conclusion: </strong> Intervening with both mother and preterm infant during initial hospitalization and the first month following hospital discharge is a promising strategy to support infant behavior, oral feeding, and infant growth, improve mother-infant interaction, and reduce infant illnesses following hospital discharge.</p> </div> </div> </div> </div> </div> </div>en
dc.subjectdevelopment interventionen
dc.subjectinfant behavior and growthen
dc.subjectpreterm infanten
dc.date.available2017-07-25T20:57:41Z-
dc.date.issued2017-07-25-
dc.date.accessioned2017-07-25T20:57:41Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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