Association of a Postnatal Parent Education Program for Abusive Head Trauma With Subsequent Pediatric Abusive Head Trauma Hospitalization Rates.
Association of a Postnatal Parent Education Program for Abusive Head Trauma With Subsequent Pediatric Abusive Head Trauma Hospitalization Rates.
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DOI：
10.1001/jamapediatrics.2016.4218
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发表时间：
2017-03-01
期刊：
影响因子：
26.1
通讯作者：
Klevens J
中科院分区：
文献类型：
--
作者：
Dias MS;Rottmund CM;Cappos KM;Reed ME;Wang M;Stetter C;Shaffer ML;Hollenbeak CS;Paul IM;Christian CW;Berger RP;Klevens J
研究表明，出生后父母的干预可能会减少婴幼儿虐待性头部创伤(AHT)的发生率。目的：评估全州普及的AHT教育对宾夕法尼亚州AHT住院率的影响，以及对父母自我报告的知识获取和育儿行为的影响。在干预前和干预期间，宾夕法尼亚州AHT住院率的变化与同期其他5个缺乏普遍父母AHT教育的州进行了比较。数据从宾夕法尼亚州各地的产科病房和分娩中心收集，从2003年1月1日至2013年12月31日在这些病房出生的1593 834名婴儿的父母那里收集。父母的行为和知识通过即刻(n=16111)和干预后7个月的父母调查(n=146)在可评估的父母的协议分析中被评估。家长们阅读了一本小册子，观看了一段8分钟的关于婴儿哭泣和AHT的视频，询问了护士的问题，并签署了一份承诺声明，确认他们的参与。每个单元上都张贴了教育海报。宾夕法尼亚州和其他5个州干预前后AHT住院率的变化。次要结果包括自我报告的知识增长和父母养育方式的改变。共有1180 291名0至23个月儿童的家长(74.1%)签署了承诺书。在干预期间，宾夕法尼亚州因AHT住院的发病率比率从每10万名0-23个月儿童24.1(95%CI，22.1-26.3)上升到26.6(95%CI，24.9-28.4)；宾夕法尼亚州的变化与其他5个州的总体变化没有显著差异，从每10万名0-23个月儿童22.4(95%CI，21.2-23.6)到22.0(95%CI，21.2-22.8)。共有16 111名家长(21.5%为男性，78.5%为女性)完成了产后调查。尽管总体上74.1%的家长坚持干预措施，但只有20.6%的家长看到了宣传册和视频，只有5.7%的父母接触到了整个干预措施。在产后调查中回答个别问题的受访者中，10958名母亲(91.0%)和2950名父亲(88.6%)表示对理解婴儿哭是正常的有很大了解；11023名母亲(92.2%)和2923名父亲(88.9%)负责抚慰婴儿，11396名母亲(94.6%)和3035名父亲(91.9%)负责抚慰自己；10060名母亲(85.1%)和2688名父亲(83.4%)选择其他婴儿照顾者；11435名母亲(94.8%)和3201名父亲(95.8%)认为，这些信息会降低摇晃婴儿的可能性。在完成了为期7个月的调查的143名受访者中，109人(76.2%)报告说，当他们的孩子哭泣时，他们记得这一信息。这种干预与儿科AHT住院率的降低无关，但与自我报告的父母知识的增加有关，这些知识被保留了7个月。
Studies suggest that a postnatal parental intervention may reduce the incidence of abusive head trauma (AHT) of infants and young children. To assess the effect of statewide universal AHT education for parents on AHT hospitalization rates in Pennsylvania and on parents’ self-reported knowledge gains and parenting behaviors. Changes in AHT hospitalization rates in Pennsylvania before and during the intervention were compared with those in 5 other states lacking universal parental AHT education during the same period. Data were collected from maternity units and birthing centers throughout Pennsylvania from the parents of 1 593 834 infants born on these units from January 1, 2003, to December 31, 2013. Parental behavior and knowledge were assessed through immediate (n = 16 111) and 7-month postintervention (n = 146) parent surveys in a per protocol analysis of evaluable parents. Parents read a brochure, viewed an 8-minute video about infant crying and AHT, asked questions of the nurse, and signed a commitment statement affirming their participation. Educational posters were displayed on each unit. Changes in AHT hospitalization rates before and during the intervention in Pennsylvania and 5 other states. Secondary outcomes included self-reported knowledge gains and changes in parenting practices. A total of 1 180 291 parents (74.1%) of children ranging in age from 0 to 23 months signed a commitment statement. Incidence rate ratios for hospitalization for AHT increased in Pennsylvania from 24.1 (95% CI, 22.1-26.3) to 26.6 (95% CI, 24.9-28.4) per 100 000 children aged 0 to 23 months during the intervention period; changes in Pennsylvania were not significantly different from aggregate changes in the 5 other states, from 22.4 (95% CI, 21.2-23.6) to 22.0 (95% CI, 21.2-22.8) per 100 000 children aged 0 to 23 months. A total of 16 111 parents (21.5% men, 78.5% women) completed the postnatal survey. Despite an overall 74.1% adherence with the intervention, only 20.6% of parents saw the brochure and video and only 5.7% were exposed to the entire intervention. Among the respondents answering individual questions on the postnatal surveys, 10 958 mothers (91.0%) and 2950 fathers (88.6%) reported learning a lot about understanding infant crying as normal; 11 023 mothers (92.2%) and 2923 fathers (88.9%), calming their infant, 11 396 mothers (94.6%) and 3035 fathers (91.9%), calming themselves; 10 060 mothers (85.1%) and 2688 fathers (83.4%), selecting other infant caregivers; and 11 435 mothers (94.8%) and 3201 fathers (95.8%), that the information would decrease the likelihood of shaking an infant. Among the 143 respondents completing the 7-month survey, 109 (76.2%) reported remembering the information while their child was crying. This intervention was not associated with a reduction in pediatric AHT hospitalization rates but was associated with self-reported gains in parental knowledge that were retained for 7 months.
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