Article

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

Arizona State University, Phoenix, Arizona, United States
PEDIATRICS (Impact Factor: 5.3). 12/2006; 118(5):e1414-27. DOI: 10.1542/peds.2005-2580
Source: PubMed

ABSTRACT 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.
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.
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.
Parental stress, depression, anxiety, and beliefs; parent-infant interaction during the NICU stay; NICU length of stay; and total hospitalization were measured.
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.
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.

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Available from: Bernadette Mazurek Melnyk, Feb 02, 2015
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    • "Topics that were covered were: managing stress; being with your baby; feeding your baby; touching and holding your baby; baby cues; your voice and baby; moving from NICU to another unit; managing anxiety; taking baby home; developmental milestones and explaining prematurity to others. This group differs from the COPE model (Melnyk et al., 2006) as it is given in a faceto-face method. The group also differs from the Avon Premature Infant Project (APIP, 1998) conducted in Bristol in the UK. "
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    • "Early inclusion of the parents became an essential part of medical care of preterm infants [23] [24] [25] because early positive experience of parent–child interaction is the foundation for optimal neurodevelopment and may reduce the need of subsequent hospitalization [26] [27]. Studies suggest that the effect of early parental interaction can be even improved by add-on programs, which focus on specific parental education to enhance the recognition of an infant's subtle signs, and toward being receptive for their limited capacity to respond to stress by giving comprehensive tutorials by specially trained staff [28] [29] [30] [31]. "
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    • "However, despite existing evidence for including parents in early intervention there is a paucity of research on parenting interventions, interventions that focus on improvements in generalisable parenting skills, for parents of infants born very preterm. A randomised, controlled trial (RCT) with 260 families of infants born preterm (\34 weeks gestation) demonstrated the effectiveness of an educational program delivered via audiotapes and written materials in decreasing parental stress and improving parent-infant interaction (Melnyk et al. 2006). In addition, the mother-infant transaction programme has recently been found to improve maternal responsivity, mother-infant interactions and infant regulation in a cohort of 68 families of preterm infants (Newnham et al. 2009). "
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