ORIGINAL ARTICLE

Randomised trial of a parenting intervention during neonatal intensive care

Cris Glazebrook¹, Neil Marlow², Christine Israel³, Tim Croudace⁴, Samantha Johnson², Ian R White⁵ and Andrew Whitelaw³

¹ School of Community Health Sciences, University of Nottingham, Nottingham, UK
² School of Human Development, University of Nottingham, Nottingham, UK
³ Department of Clinical Science at North Bristol, University of Bristol, Bristol, UK
⁴ Department of Psychiatry, University of Cambridge, Cambridge, UK
⁵ MRC Biostatistics Unit, Cambridge, Cambridge, UK

Correspondence to:
Dr Cris Glazebrook, Division of Psychiatry, School of Community Health Sciences, A Floor, South Block, Queens Medical Centre, Nottingham NG7 2UH, UK; cris.glazebrook{at}nottingham.ac.uk

Objective: To evaluate the influence of parenting intervention on maternal responsiveness and infant neurobehavioural development following a very premature birth.

Design: Cluster-randomised controlled trial, with a crossover design and three-month washout period.

Setting: Six neonatal intensive care units.

Patients: Infants born <32 weeks’ gestation.

Intervention: The Parent Baby Interaction Programme (PBIP) is a supportive, educational intervention delivered by research nurses in the neonatal intensive care unit, with optional home follow-up for up to six weeks after discharge.

Main outcome measures: Parenting stress at 3 months adjusted age, as measured by the Parenting Stress Index (PSI). Other outcomes included the Neurobehavioural Assessment of the Preterm Infant (NAPI) and maternal interaction as assessed by the Nursing Child Assessment Teaching Scale (NCATS) and the responsivity subscale for Home Observation for Measurement of the Environment (HOME).

Results: 112 infants were recruited in the intervention phases and 121 in the control phases. Mean standardised NAPI scores at 35 weeks did not differ between the PBIP and control groups. Both groups had low but similar NCATS caregiver scores before discharge (36.6 in the PBIP group and 37.4 in control, adjusted mean difference –0.7, 95% CI –2.7 to 1.4). At three months, adjusted age mean PSI scores for the PBIP group were 71.9 compared with 67.1 for controls (adjusted mean difference 3.8, 95% CI –4.7 to 12.4). NCATS scores and HOME responsivity scores were similarly distributed between the groups.

Conclusion: This early, nurse-delivered, parent-focused interaction programme intervention had no measurable effects on short-term infant neurobehavioural function, mother–child interaction or parenting stresses.

Abbreviations: HOME, Home Observation for Measurement of the Environment; IMD, index of multiple deprivation; NAPI, Neurobehavioural Assessment of the Preterm Infant; NCATS, Nursing Child Assessment Teaching Scale; PBIP, Parent Baby Interaction Programme; PSI(-SF), Parenting Stress Index (short form)

Keywords: cluster randomised trial; interaction; parental stress; preterm infant; very premature birth

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