120 Effectiveness of interventions on parental sensitivity, infant neurodevelopment and parental stress in the NICU: Results from a systematic review & meta-analysis
Bibliographic record
Abstract
Parental sensitivity is the parent’s ability to recognize and interpret their infant’s cues, and identify and apply an appropriate response quickly. Sensitivity is central to the parent-infant relationship and predicts long-term attachment which also influences the child’s neurodevelopment. Parents of preterm infants are not less sensitive than parents of term infants but preterm infants may need more sensitive parenting. Moreover, increased parental stress in the NICU negatively influences parental sensitivity. Prior to NICU discharge, passive and active interventions, the former being interventions where parents receive information and the latter where parents participate in an aspect of their infant’s care, have been evalauated. Yet, no systematic review has examined the effect of both passive and active interventions as different types of interventions and their respective effects on sensitivity, nor have they examined their effects on neurodevelopment and parental stress. The primary objective of this systematic review is to examine the characteristics of passive and active interventions designed to enhance parental sensitivity. The secondary objective of this systematic review and meta-analysis is to examine the effectiveness of early interventions for parents of preterm infants on parental sensitivity, parental stress and preterm infant neurodevelopment, compared to standard care. We adhere to the protocol which has previously been published and registered in the PROSPERO database (registration number: CRD42016047083). Eight databases have been searched. To be included, studies had to be randomized controlled trials (RCT) of early interventions for parents of preterm infants implemented in NICUs with parental sensitivity as a primary outcome and infant neurodevelopment as secondary outcome. Parental stress was added as a secondary outcome retrospectively because it was measured in many of the included RCTs. Intervention caracteristics were qualitatively summerized. Because more than one study was available, a meta-analysis was conducted for the parental sensitivity outcome and for the parental stress outcome using a random effects model. The literature search resulted in 7403 references. Following the study selection process, 24 papers accounting for eighteen studies published from 1988 to 2017 were included in the systematic review. These studies reported on fifteen different interventions. Interventions are often composed of an educational component where parents are taught their preterm infant’s cues. Parental participation in care using guided participation is also common and seems beneficial to promote sensitivity in the NICU. Only four interventions included fathers. Parents had a passive role in five interventions and had an active role in 14 interventions. Active parental participation included participation in kangaroo care, stimulation of their infant’s senses and participation in their infant’s care. The meta-analysis shows that passive interventions have an overall small but significant effect on parental sensitivity. Active interventions show no significant effect on this outcome. Both active and passive interventions also show no significant effect on parental stress. Infant neurodevelopment could not be considered in the meta-analysis because of insufficient data. This is the first systematic review examining the effectiveness of interventions promoting sensitivity of parents of preterm infants in the NICU. Regardless of the meta-analysis results, this systematic review will guide clinical practice for the implementation of interventions in NICUs to enhance parental sensitivity, optimize neurodevelopment of preterm infants, and lower parental stress. Results also guide research and the development of intervenions to further enhance sensitivity in the NICU.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.038 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.029 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".