Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis.
Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis.
复制标题
早产婴儿及其父母的早期干预计划的关键组成部分：系统的审查和荟萃分析。
DOI：
10.1186/1471-2393-13-s1-s10
复制
发表时间：
2013
影响因子：
3.1
通讯作者：
Ballantyne M
中科院分区：
文献类型：
--
作者：
Benzies KM;Magill-Evans JE;Hayden KA;Ballantyne M
早产儿比足月儿患神经发育障碍的风险更大。支持父母改善婴儿环境质量的干预措施应该可以改善早产儿的发育结果。许多涉及父母的干预措施并没有衡量父母的变化，也不清楚哪些干预措施与改善父母的结果相关。本次综述的目的是对早期干预计划的关键组成部分进行分类，并确定这些组成部分对父母及其早产儿的直接影响。检索了 1990 年至 2011 年 12 月期间的 MEDLINE、EMBASE、CINAHL、ERIC 和 Cochrane 系统评价数据库。符合条件的随机对照试验 (RCT) 包括对早产儿的早期干预，涉及父母，并有社区成分。在确定的 2465 篇标题和摘要中，筛选了 254 篇全文文章，其中 18 篇符合纳入标准。其中十一项研究报告了母亲在与婴儿互动时的压力、焦虑、抑郁症状、自我效能以及敏感性/反应性的结果。使用随机效应模型对这 11 项研究进行了荟萃分析。干预措施采用多种成分，分为（a）心理社会支持，（b）家长教育，和/或（c）针对婴儿的治疗性发育干预措施。所有干预措施都使用某种形式的育儿教育。根据 Cochrane 协作工具，大多数试验的报告质量足够，且偏倚风险较低。荟萃分析表明，干预措施对孕产妇压力（Z = 0.40，p = 0.69）和敏感性/反应性（Z = 1.84，p = 0.07）的影响有限。干预措施对产妇焦虑（Z = 2.54，p = 0.01）、抑郁症状（Z = 4.04，p <.0001）和自我效能（Z = 2.05，p = 0.04）具有积极的综合效应。早期干预对早产儿母亲的某些心理社会方面产生了积极且具有临床意义的影响。这项审查受到结果测量的异质性和统计报告不充分的限制。对早产儿及其母亲的干预措施应考虑包括对母亲的心理社会支持。如果干预涉及母亲，则应测量母亲和早产儿的结果，以更好地了解变化机制。
Preterm infants are at greater risk for neurodevelopmental disabilities than full term infants. Interventions supporting parents to improve the quality of the infant’s environment should improve developmental outcomes for preterm infants. Many interventions that involve parents do not measure parental change, nor is it clear which intervention components are associated with improved parental outcomes. The aim of this review was to categorize the key components of early intervention programs and determine the direct effects of components on parents, as well as their preterm infants. MEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Database of Systematic Reviews were searched between 1990 and December 2011. Eligible randomized controlled trials (RCTs) included an early intervention for preterm infants, involved parents, and had a community component. Of 2465 titles and abstracts identified, 254 full text articles were screened, and 18 met inclusion criteria. Eleven of these studies reported maternal outcomes of stress, anxiety, depressive symptoms, self-efficacy, and sensitivity/responsiveness in interactions with the infant. Meta-analyses using a random effects model were conducted with these 11 studies. Interventions employed multiple components categorized as (a) psychosocial support, (b) parent education, and/or (c) therapeutic developmental interventions targeting the infant. All interventions used some form of parenting education. The reporting quality of most trials was adequate, and the risk of bias was low based on the Cochrane Collaboration tool. Meta-analyses demonstrated limited effects of interventions on maternal stress (Z = 0.40, p = 0.69) and sensitivity/responsiveness (Z = 1.84, p = 0.07). There were positive pooled effects of interventions on maternal anxiety (Z = 2.54, p = 0.01), depressive symptoms (Z = 4.04, p <.0001), and self-efficacy (Z = 2.05, p = 0.04). Positive and clinically meaningful effects of early interventions were seen in some psychosocial aspects of mothers of preterm infants. This review was limited by the heterogeneity of outcome measures and inadequate reporting of statistics. Interventions for preterm infants and their mothers should consider including psychosocial support for mothers. If the intervention involves mothers, outcomes for both mothers and preterm infants should be measured to better understand the mechanisms for change.