Interaction between preterm infants and their parents : Studies of early interventions in neonatal care

Abstract: Background  Preterm birth negatively affects infant well-being and development. A well-functioning parent-infant interaction can mitigate the risk of preterm birth on infant development. However, parent-infant interaction is often disrupted after preterm birth because of organizational factors in care, infants’ immature interaction cues, and maternal health problems. Different interventions supporting parental-infant interaction exist, but only a few target support for interaction between preterm infants born at gestational week 30-36 and their parents. Thus, an early, feasible and effective intervention that supports the preterm infant and the parents in the neonatal intensive care unit was needed. Aim  The overall aim of the thesis was two-fold; first to evaluate the early intervention skin-to-skin contact on mother-infant interaction; and second, to develop a new intervention, the Early Collaborative Intervention (EACI), to explore how mothers’ experience the new intervention, and to study its effects on mother-infant interaction.  Methods  Study I was a randomized controlled trial with two groups. Families were randomly assigned to either continuous or intermittent skin-to-skin con-tact directly after birth. Mother-infant interaction was video recorded when the infant was four months corrected age during a Still face procedure. The interaction was later scored using two different instruments, the Ains-worth’s Maternal Sensitivity Scales and the Maternal Sensitivity and Responsivity Scale. Furthermore, the dose-response relationship between time in skin-to-skin contact and interaction quality was calculated.   Study II had a descriptive design where the rationale, development, frame-work, and practical provision of the EACI program was described.   Study III had a qualitative design. Mothers were interviewed about their experiences of the EACI. Data were analyzed with reflexive thematic analysis.   Study IV was a randomized controlled trial with two groups. Families were randomly assigned to either the EACI or standard care. The intervention started within three days after birth. Mother-infant interaction was video recorded when the infant was one month corrected age during a bathing session. The interaction was later scored using two different instruments, the Ainsworth’s Maternal Sensitivity Scales, and the Emotional Availability system. Intention to treat and per protocol analysis were calculated as three sessions were considered the minimum required to detect a difference.    Results  Study I showed no significant differences in maternal interaction behavior between the groups randomized to continuous skin-to-skin contact or intermittent skin-to-skin contact. Dose-response calculations between time in skin-to-skin-contact and interaction quality showed no correlations. In Study II, the theoretical framework of the EACI was based on the attachment theory, the assessment of infant behavior described by Brazelton, and psychoeducational theory. The rationale was to provide tailored early support that improved parent-infant interaction and thereby optimized infant well-being and development. The intervention was developed by a core group in the neonatal intensive care unit at Crown Princess Victoria Children’s Hospital. It was a three-session intervention, provided during an ordinary care procedure with instant provider feedback and hands on guidance during active parental involvement. Two sessions were provided at the hospital, and one after discharge in the home of the family. In Study III two main themes were constructed, “mothers feelings evoked from the Early Collaborative Intervention” and “based on the preterm baby’s behavior”. The mothers experienced the intervention as helpful for their interaction with the infant and for them to see their infant as an individual. The per protocol analysis in Study IV showed that the intervention group had significantly higher mean scores in the Availability, Acceptance and Non-hostility subscales, indicating a more well-functioning interaction.   Conclusion  Continuous SSC was not superior to intermittent SSC for improving maternal interactive behavior. In contrast, the Early Collaborative Intervention, improved maternal interactive behavior if all three sessions of the intervention were provided. This was also confirmed in the interviews, in which the mothers described the intervention as helpful for their interactive behavior with their preterm infants.