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: 5.47). 12/2006; 118(5):e1414-27. DOI: 10.1542/peds.2005-2580
Source: PubMed


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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    • "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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    ABSTRACT: Aim – to understand both the parental experience of the NICU and the mothers’ view of a NICU Parent Support Group Background - Mothers of babies who are born premature have their first experiences of parenting while their infant is in the neonatal intensive care unit (NICU). This presents multiple challenges and a range of stresses related to their role as a mother and concerns about their baby’s survival and growth. Thus, various supportive interventions have been trialled with this NICU parent population. However the focus of this support and how it should be delivered lacks research as an evidence base for practice. Mothers’ experiences of the NICU and a professionally facilitated NICU support group at a city hospital were explored in this qualitative research study. Method - Nine mothers in 2010 were interviewed while their babies were NICU inpatients. Interviews were recorded, transcribed and analysed thematically. Results - The NICU admission resulted in parents facing challenges in getting to know their baby, forming their parenting role while in the NICU, and a reliance upon, but resentment toward, nursing staff. Positive feelings about their baby’s strengths were also apparent. The parent support group was an important part of managing the experience of the NICU and was reported to meet the emotional support needs of these NICU parents. Conclusion - The implications and recommendations for NICU based emotional support are discussed. In particular modifications to support group structures to ensure professional staff involvement and a balance between education and emotional care are reviewed.
    Full-text · Article · Mar 2015 · Journal of Reproductive and Infant Psychology
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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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    ABSTRACT: To investigate influences on the interaction between preterm infants and their parents by a dedicated parental training program on the care of preterm infants. Standardized scenarios of mother-child interactions (50 mother-child dyads of very low birth weight infants (VLBWI), birth weight<1500g) were videotaped in two perinatal centers (PC-A, PC-B). The videos were reviewed and scored using a standardized instrument. In both centers, parents were integrated in the daily care by pediatric nurses, while additionally PC-A had a structured parental training program. PC-A and PC-B were comparable regarding patient spectrum and number of admissions of VLBWIs/year. Both centers had similar care values with respect to the "baby friendly" initiative. No significant differences were seen in characteristics of patients (gestational age, birth weight, postnatal age) and mothers (age, parity, marital status, professions). However, in scoring the mother-child interactions significant differences were observed: In contrast to PC-B the recorded behavior in mother-child dyads of PC-A was significantly more often scored as interaction-oriented. A dedicated, structured, and actively encouraging training program for parents of preterm infants was found to be more strongly correlated toward neurodevelopmental enhancing mother-child-interactions than an approach of merely integrating parents into daily care routine. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Feb 2015 · Early Human Development
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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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    ABSTRACT: Infants born very preterm are at risk of developmental and behavioural problems and their parents are at risk of psychological distress and compromised parenting. This study has two key aims: (1) to identify, from the parents’ own perspective, the unique aspects of parenting an infant born very preterm and (2) to assess parent preferences for support including opinions of a new, tailored parenting intervention, Prem Baby Positive Parenting Program (Triple P). A qualitative approach was taken with focus groups of 18 parents of infants born preterm and a thematic analysis conducted. Parents identified several unique aspects of parenting an infant born preterm including: difficulty coping with the stress of hospitalisation; institutionalisation to the hospital environment; a lack of preparation for the transition to parenthood; grief; isolation; getting into “bad parenting habits” of overnurturance and a lack of certainty about developmental expectations. Parents preferred parenting support that is tailored to parents of infants born preterm, has flexible delivery, enhances coping skills and the spousal relationship and is sensitive to the emotional context of parenting an infant born preterm. Understanding the experiences and the preferences of parents of infants born preterm is an important step in tailoring parenting interventions to fit their needs.
    Full-text · Article · Aug 2014 · Journal of Child and Family Studies
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