Background
Methods
Methodological quality assessment and data analysis
Results
Study selection
Authors and year of publication | Title of the study | Aim | Study designs | Included databases | Number. of studies included |
---|---|---|---|---|---|
Evans et al., 2014 [26] | Are parenting interventions effective in improving the relationship between mothers and their preterm infants? | To systematically review the efficacy of parenting interventions in improving the quality of the relationship between mothers and preterm infants | RCTs and quasi-experimental designs | The Cochrane Library, PubMed, CINAHL, PsycINFO and Web of Science | 17 |
Benzies et al., 2013 [30] | Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis | To categorise the key components of early intervention programs and determine the direct effects of components on parents, as well as their preterm infants | RCTs | MEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Database of Systematic Reviews | 18 |
Brett et al., 2011 [25] | A systematic mapping review of effective interventions for communicating with, supporting and providing information to parents of preterm infants | To identify and map out effective interventions for communication with, supporting and providing information for parents of preterm infants. | RCTs, quasi-experimental and non-intervention studies | Medline, Embase, PsychINFO, the Cochrane library, CINAHL, Midwives Information and Resource Service, Health Management Information Consortium, Health Management and Information Service | 72 |
Herd, et al., 2014 [32] | Efficacy of preventative parenting interventions for parents of preterm infants on later child behaviour: a systematic review and meta-analysis | To determine the efficacy of parenting interventions for parents of preterm infants to improve child behaviour | RCTs | PubMed, CINAHL, Scopus, PsychINFO, web of science, Cochrane library | 12 |
Goyal et al., 2013 [33] | Home Visiting and Outcomes of Preterm Infants: A Systematic Review | To review evidence regarding home visiting and outcomes of preterm infants | RCTs and Cohort studies | Medline, CINAHL, Cochrane library, PsycINFO, EMBASE | 17 |
Vanderveen et al., 2009 [23] | Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis | To determine whether interventions for infant development that involve parents, improve neurodevelopment at 12 months corrected age or older | RCTs | MEDLINE, CINAHL, PsychINFO, Cochrane library | 25 |
Spittle al., 2015 [34] | Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants | To compare the effectiveness of early developmental intervention programmes provided post hospital discharge to prevent motor or cognitive impairment in preterm (< 37 weeks) infants versus standard medical follow-up of preterm infants at infancy (zero to < three years), preschool age (three to < five years), school age (five to < 18 years) and adulthood (≥ 18 years) | RCTs and Quasi- RCTs | Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, PsycINFO, Embase | 25 |
Boundy et al., 2016 [21] | Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis | To conduct a systematic review and meta-analysis estimating the association between KMC and neonatal outcomes | RCTs and observational studies | PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Latin American and Caribbean Health Sciences Information System (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR), and Western Pacific Region Index Medicus (WPRIM). | 124 |
Lawn et al., 2010 [31] | Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications | To review the evidence, and estimate the effect of KMC on neonatal mortality due to complications of preterm birth. | RCTs and observational studies | Cochrane Libraries, PubMed, LILACS, African Medicus, EMRO and all World Health Organization Regional Databases | 15 |
McGregor et al., 2012 [35] | Enhancing parent-infant bonding using kangaroo care: a structured review | To review the literature on the effectiveness of kangaroo care with premature infants for enhancing bonding. | RCTs and observational studies | Medline, CINAHL, OTDBASE, PsycINFO, Applied Social Sciences Index and Abstracts (ASSIA), Allied and Complimentary Medicine Database (AMED), and British Nursing Index (BNI) | 6 |
Zhang et al., 2014 [24] | Early Intervention for preterm infants and their mothers | To evaluate the efficacy of early interventions on maternal emotions, mother-infant interaction and infant development outcomes | RCTs | PubMed, CINAHL, EMBASE, PsychINFO, Cochrane library | 12 |
Characteristics of the included systematic reviews
Study | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | Total |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Benzies et al., 2013 [30] | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 6 |
Boundy et al., 2016 [21] | 0 | 1 | 1 | 1 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 7 |
Brett et al., 2011 [25] | 0 | 1 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 5 |
Evans et al., 2014 [26] | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 0 | 4 |
Goyal et al., 2013 [33] | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 0 | 4 |
Herd, et al., 2014 [32] | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 1 | 5 |
Lawn et al., 2010 [31] | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 0 | 1 | 5 |
McGregor and Casey, 2012 [35] | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 2 |
Spittle et al., 2015 [34] | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 1 | 9 |
Vanderveen et al., 2009 [23] | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 3 |
Zhang et al., 2014 [24] | 0 | 1 | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 4 |
Participants
Interventions
Name of the intervention programme | Reviews reporting the intervention | Intervention components | Intervention focus | Mode of delivery | Place of delivery | Frequency/Duration | Additional details of the intervention | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Total number | Details provided | Parent education | Parent support | Infant support/therapy | Mother/Parent | Child | Individual | Group | Hospital | Community/ Home | |||
APIP | N = 4 | N = 2 | N = 2 | N = 1 | – | √ | – | √ | – | – | √ | Weekly session for 2 years | Initiated from discharge |
CAMS | N = 1 | N = 1 | N = 1 | – | N = 1 | √ | √ | NR | NR | NR | NR | Not Reported (NR) | Information was reported only on the intervention component |
CBIP | N = 1 | N = 1 | N = 1 | N = 1 | √ | √ | √ | – | √ | – | 5 inpatient sessions | – | |
COPE | N = 4 | N = 3 | N = 3 | – | – | √ | – | √ | – | √ | √ | 1–8 sessions before discharge (BD) and 1 week session after discharge (AD) | – |
CP | N = 1 | N = 1 | N = 1 | N = 1 | – | √ | – | √ | – | √ | √ | 5 sessions in the Neonatal Intensive Care Unit,1 home visit | Home visit within 4 weeks AD |
DIG | N = 1 | N = 1 | N = 1 | – | – | √ | – | – | √ | – | √ | Once a day for period of 1 week | Initiated immediately AD |
EG | N = 1 | N = 1 | N = 1 | – | – | √ | – | – | √ | – | √ | Once a day for period of 1 week | Initiated immediately AD |
EI | N = 1 | N = 1 | N = 1 | – | – | √ | – | √ | – | √ | √ | 1NICU session, 1 home visit session | Home visit is done within first 60 weeks of adjusted infant age |
GP | N = 2 | N = 1 | N = 1 | N = 1 | – | √ | – | – | √ | √ | √ | 6 session | – |
HBIP | N = 1 | N = 1 | – | N = 1 | N = 1 | √ | √ | √ | – | – | √ | 8 neonatal clinic visits | Neonatal visit is initiated AD from hospital |
H-HOPE | N = 1 | N = 1 | N = 1 | – | N = 1 | √ | √ | √ | – | √ | – | 4 sessions at NICU | Sessions within 1 month adjusted infant age |
IBAIP | N = 3 | N = 3 | N = 2 | – | N = 3 | √ | √ | √ | – | √ | 6 to 8 home visits | Within 6 months AD | |
IC | N = 1 | N = 1 | – | N = 1 | N = 1 | √ | √ | √ | – | – | √ | 8 sessions AD | Within 12-15 weeks |
IDP | N = 1 | N = 1 | – | N = 1 | N = 1 | √ | √ | √ | – | √ | – | 3-4weekly session in the hospital | Initiated AD |
IFBI | N = 1 | N = 1 | N = 1 | N = 1 | √ | √ | √ | – | – | √ | 3–17 sessions | Within 8 weeks AD | |
IHDP | N = 5 | N = 5 | N = 1 | N = 2 | N = 5 | √ | √ | √ | – | √ | √ | Weekly home visits for a year, then 1 visit/2 weeks for next 2 years | Sessions from discharge to 3 years of infant age |
JIMHP | N = 1 | N = 1 | – | N = 1 | – | √ | – | √ | – | – | √ | 5 sessions AD | Sessions at 1,3,5 and 12 months |
KC | N = 8 | N = 6 | – | N = 5 | N = 3 | √ | √ | √ | – | √ | √ | Up to 10 sessions AD | Frequency of hospital sessions not reported |
KS | N = 1 | N = 1 | – | N = 1 | – | √ | – | NR | NR | – | √ | 4 times per day for 1 month | Start from term |
MITP | N = 7 | N = 5 | N = 1 | N = 3 | – | √ | – | √ | – | √ | √ | 1 session BD and 4 sessions AD | AD sessions within first 3 months |
M-MITP | N = 3 | N = 3 | N = 3 | N = 3 | – | √ | – | √ | – | √ | √ | 1 session BD and 4 sessions AD | AD sessions within first 3 months |
NBAS | N = 1 | N = 1 | N = 1 | – | – | √ | – | NR | NR | NR | NR | NR | – |
NCATS | N = 4 | N = 1 | N = 1 | – | – | √ | – | √ | – | NR | NR | NR | – |
NIDCAP | N = 2 | N = 1 | – | N = 1 | N = 1 | √ | √ | √ | – | √ | – | NR | – |
NSTEP-P | N = 2 | N = 2 | N = 2 | N = 2 | – | √ | – | √ | – | – | √ | 9 home visits | Within 5 months AD |
PBIP | N = 4 | N = 2 | N = 1 | – | – | √ | – | √ | – | √ | √ | Weekly session BD and 6 sessions AD | Session before discharge starts at birth |
PPI | N = 1 | N = 1 | N = 1 | N = 1 | – | √ | – | √ | √ | √ | √ | 5 sessions BD and 1 session AD | Sessions at home within 1-12 weeks AD |
PI | N = 1 | N = 1 | – | N = 1 | – | √ | – | NR | NR | – | √ | Once a month session for 12 months | Home or out-patient department |
SG | N = 1 | N = 1 | N = 1 | N = 1 | – | √ | – | – | √ | – | √ | Weekly sessions for 0-3 months, 2 sessions per month 3–9 months 1session per month 9-12 months | Start from term |
SII | N = 1 | N = 1 | – | N = 1 | N = 1 | √ | √ | √ | – | √ | – | 3 sessions BD | Last session on discharge day |
SM | N = 1 | N = 1 | – | N = 1 | N = 1 | √ | √ | √ | – | √ | √ | 1 session BD or AD | – |
SPEEDI | N = 1 | N = 1 | N = 1 | – | N = 1 | √ | √ | √ | – | – | √ | 20 min sessions 5 times/week | Each family received at least 10 visits |
TH | N = 1 | N = 1 | – | N = 1 | N = 1 | √ | √ | √ | – | √ | √ | 1 h blanket holding daily | Frequency not specified |
VIBeS Plus | N = 2 | N = 2 | N = 2 | N = 2 | – | √ | – | √ | – | – | √ | 9 sessions in 12 months | Initiated from discharge |
Effectiveness of interventions on outcomes
Mother-infant dyadic outcomes
Mother- infant dyadic outcomes | Review | Intervention | Effectiveness on the outcome | Additional information on impact | ||
---|---|---|---|---|---|---|
Positive impact | No impact | Inconclusive | ||||
Quality of the mother–infant relationship | Evans et al., 2014 [26] | SM, NSTEP-P, KC, TH, MITP | √ | – | – | Effect sizes ranged from small, 0.38 to large, 2.81 |
Symmetrical co-regulation | KC | √ | – | – | large effect size 2.72 | |
Asymmetrical co-regulation | KC | √ | – | – | large effect size −2.81 | |
Mutual attention | MITP | √ | – | – | large effect size 1.95 | |
Maternal sensitivity and/or responsiveness in interactions with the infant | Benzies et al., 2013 [30] | PBIP, COPE, MITP, M-MITP, NSTEP-P | – | – | √ | Overall effect was not significant. Pooled effect Z = 1.84 (P = 0.07). Included studies showed positive effect of MITP and M-MITP |
Zhang et al., 2014 [24] | H-HOPE, MITP, COPE, EI | √ | No effect size reported | |||
Mother –infant attachment | McGregor et al., 2012 [35] | KC | √ | – | – | Five of the six studies reported significant improvements |
Mother-infant interaction | Goyal et al., 2013 [33] | Home based interventions (unspecified) | √ | – | – | No effect size reported. 13 of the 14 studies reported positive intervention effect on any parent-infant interaction measures |
McGregor et al., 2012 [35] | KC | √ | – | – | At 6 months, mother-infant interactions were significantly more optimal for the KC group (p < 0.05). | |
Zhang et al., 2014 [24] | MITP, M-MITP, COPE, H-HOPE, EI | √ | – | – | No effect size reported |
Maternal/ parental outcomes
Maternal/parental outcomes | Review | Intervention | Effectiveness of the intervention on outcome | Additional information on impact | ||
---|---|---|---|---|---|---|
Positive impact | No impact | Inconclusive | ||||
Quality of mother–infant relationship for mothers | Evans et al., 2014 [26] | GP | √ | – | – | Large effect sizes using observation measure (2.09) and interview measure (1.20) |
SM-NSTEP-P | √ | – | – | Positive impact for mothers with low education, with effect size 0.86 | ||
Brett et al., 2011 [25]a | Parent support groups/parent led peer support | √ | – | – | Evidence reported from a non-RCT study for mothers of critically ill preterm babies | |
Maternal/parental stress alleviation | Benzies et al. 2013 [30] | M-MITP, NBAS, COPE, PBIP, IBAIP | – | – | √ | Pooled effect z = 0.40 (p = 0.69) |
Brett et al., 2011 [25]a | COPE, MITP, NIDCAP | √ | – | – | Evidence reported from four high quality and well conducted RCTs. No significant reduction in parental stress from NIDCAP at 1–2 weeks after the baby was born | |
Home support programmes where parents are visited regularly for the first year and for upto three years afterwards | √ | – | – | Based on RCT evidence with high risk of bias. Specific details of the intervention unclear | ||
McGregor et al., 2012 [35] | KC | √ | – | – | Reduction in stressful situations (32%), heart rate (7%) and Pain Visual Analogue Scale score (89%) | |
Zhang et al., 2014 [24] | M-MITP, COPE, MITP | √ | – | – | Impact until the baby is 12 months old with MITP | |
Reduction in maternal/parental anxiety | Benzies et al. 2013 [30] | COPE, VIBeS Plus, NBAS | √ | – | – | Positive pooled effect z = 2.54 (P = 0.01) |
Zhang et al., 2014 [24] | Not specified | – | √ | – | Used State Trait Anxiety Inventory scale to measure anxiety | |
Brett et al., 2011 [25]a | KC | √ | – | – | Significant reduction in maternal anxiety around her infant. RCT evidence showing music during KC resulted in significantly lower maternal anxiety | |
Reduction in maternal depressive symptoms | Benzies et al. 2013 [30] | COPE, VIBeS Plus, M-MITP, | √ | – | – | Positive pooled effect z = 4.04(P < 0.0001) |
Zhang et al., 2014 [24] | MITP, COPE | √ | – | – | Positive impact on depressive symptoms after the infant was discharged home. Statistical significance not reported | |
Brett et al., 2011 [25]a | KC | √ | – | – | Significantly less postnatal depression compared with the controls at 37 weeks | |
Maternal self-efficacy | Benzies et al. 2013 [30] | NBAS | √ | – | – | Pooled effect z = 2.05 (P = 0.04) |
Parental confidence/ competence/ satisfaction | Goyal et al., 2013 [33] | Home visiting programmes | √ | – | – | Name of the interventions not specified |
Brett et al., 2011 [25]a | MITP, KC | √ | – | – | MITP significantly improved maternal satisfaction and maternal self-confidence. KC provided the mother with a significantly greater sense of competence with their infant | |
Breast feeding support programmes | √ | – | – | Improved the confidence of mothers in breastfeeding | ||
NIDCAP | – | √ | – | RCT evidence showing no impact at 1–2 weeks after birth | ||
Mother’s/Parents’ interaction with infants | Brett et al., 2011 [25]a | Discharge planning programmes | √ | – | – | Based on RCT evidence with high risk of bias. Specific details of the intervention unclear |
Home support programmes | √ | – | – | Based on RCT evidence with high risk of bias. Specific details of the intervention unclear | ||
KC | √ | Significantly greater sensitivity towards her infant. Effect size not reported. Better infant interaction, more touch, better adaptation to infant cues and better perception of their infant at all time periods. | ||||
Mother’s coping skills | Zhang et al., 2014 [24] | COPE | – | – | √ | Both positive and no impact reported. |
Preparing parents to see infant for first time | Brett et al., 2011 [25]a | Use of photograph | √ | – | – | Reported positive effect based on a well conducted RCT |
Parents’ emotional and practical guidance | Brett et al., 2011 [25]a | Home based support programmes | √ | – | – | aRCT (1-), interventions unclear |
Infant outcomes
Infant outcomes | Review | Intervention | Effectiveness of the intervention on the outcome | Additional information on impact | ||
---|---|---|---|---|---|---|
Positive impact | No impact | Inconclusive | ||||
Infant’s quality of relationship with mother | Evans et al. 2014 [26] | KC, TH, SM NSTEP-P | √ | – | – | Effect sizes ranged from small, 0.35 to large, − 1.60. Large effect size observed with KC (1.60) and TH (− 0.87) |
Behaviour improvement | Herd et al. 2014 [32] | IHDP, M-MITP, VIBeS Plus | √ | – | – | Small, but significant, effect on behaviour outcomes. IHDP improved behaviour up to 3 years of age, the VIBeS Plus program up to 4 years and the M- MITP up to 5 years |
APIP | – | √ | – | No improvement in child behaviour | ||
Zhang et al., 2014 [24] | MITP, COPE | √ | – | – | Symbolic behaviour (understanding spoken language /object use in play) | |
Temperament | Benzies et al. 2013 [30] | M-MITP | √ | – | – | Positive effect at 3 and 6 months. Effect size not reported |
Zhang et al., 2014 [24] | MITP, COPE | √ | – | – | Statistical significance not reported | |
Nutrition and growth | Goyal et al., 2013 [33] | IHDP, others not specified | – | – | √ | Mixed findings with one study demonstrating a significant intervention effect on weight and length during infancy (at 4 and 12 months) |
Boundy et al., 2016 [21] | KC | – | √ | – | No improvements in weight gain or body length growth | |
Breast feeding | Boundy et al., 2016 [21] | KC | √ | – | – | Improvements in exclusive breast feeding |
Zhang et al., 2014 [24] | MITP, COPE | √ | – | – | Improvements in general breast feeding | |
Height and head circumference | McGregor et al., 2012 [35] | KC | √ | – | – | Improvements in height & head circumference reported by one study |
Head circumference | Boundy et al., 2016 [21] | KC | √ | – | – | Improvements in head circumference |
Decrease in infant heart rate and pain | Boundy et al., 2016 [21] | KC | – | √ | – | Ineffective with respect to heart rate, respiration, and pain experience |
McGregor et al., 2012 [35] | KC | √ | – | – | Infant’s heart rates and pain scores significantly decreased during intervention (p = .007 and p = .005, respectively) and post-intervention (p = .03 and p = .04, respectively), although there was no significant differences in infants’ stress levels | |
Reduction in morbidity and health service utilisation | Goyal et al., 2013 [33] | IHDP | – | – | √ | Mixed findings. Small, statistically significant increase in maternally reported minor illnesses at 3 years of age, but only for infants weighing, 1500 g, and no effect on serious health conditions. No significant effects on rates of hospitalization or acute care visits |
Boundy et al., 2016 [21] | KC | √ | – | – | RR = 0.53 (Neonatal sepsis), RR = 0.22 (Hypothermia), RR = 0.12 (Hypoglycemia) | |
Lawn et al., 2010 [31] | KC | √ | – | – | RR = 0.34 (RCT evidence) | |
Reduction in hospital readmission | Boundy et al., 2016 [21] | KC | √ | – | – | Reduced hospital readmission by 58% |
Lower mortality | Boundy et al., 2016 [21] | KC | √ | – | – | Significant protective effect on mortality. Mortality 36% lower among low birth weight new borns. |
Lawn et al., 2010 [31] | KC | √ | – | – | Large effect size, RR = 0.49 (RCT evidence) and RR = 0.68 (non-RCT evidence) | |
Early mental development/neurodevelopment | Vanderveen et al., 2009 [23] | APIP, KC, COPE, IHDP, NIDCAP, others not specified | √ | – | – | Large effect size at 6 months Weighted Mean Difference (WMD) = 3.55, p = 0.05), 12 months (WMD = 5.57, p = 0.0009), 24 months (WMD = 7.59, p = 0.0003) and 36 months (WMD = 9.66, p < 0.0001) |
Zhang et al., 2014 [24] | MITP, COPE | √ | – | – | Statistical significance not reported | |
Long term mental development (at 5 years) | Vanderveen et al., 20,092 [23] | APIP, IHDP, others not specified | – | √ | – | WMD = −1.36, (P = 0.24) |
Early cognitive development (infancy & preschool age) | Spittle et al., 2015 [34] | Early interventions including MITP, IHDP, M-MITP, IBAIP, CBIP, HBIP, SPEEDI, others not specified | √ | – | – | Infancy -developmental quotient (DQ): standardised mean difference (SMD) 0.32 [0.16, 0.47]; P < 0.001; 16 studies; 2372 participants. Preschool age -intelligence quotient (IQ); SMD 0.43 [0.32–0.54]; P < 0.001; eight studies; 1436 participants. |
Benzies et al. 2013 [30] | M-MITP, NBAS | √ | – | – | Effective at 4 months (NBAS) and 3 and 6 months (M-MITP) | |
Long term cognitive development | Spittle et al., 2015 [34] | MITP, IHDP, APIP | – | √ | – | School age – IQ: SMD 0.18 [− 0.08, 0.43]; P = 0.17; five studies; 1372 participants |
Early motor development | Spittle et al., 2015 [34] | Early interventions including MITP, IHDP, M-MITP, IBAIP, CBIP, HBIP, SPEEDI, others not specified | √ | – | – | Small significant effect in motor development in infancy. Motor scale DQ: SMD 0.10 [0.10, 0.19] |
Long term motor development | – | √ | – | SMD −0.18, 95% CI -0.47 to 0.11; P = 0.22. Only five included studies reported outcomes at preschool age (n = 3) or at school age (n = 2). | ||
Early psychomotor development | Vanderveen et al., 2009 [23] | IHDP, NIDCAP, others not specified | √ | – | – | 6 months WMD = 3.47 (_3.92, 10.86) P = 0.36, 12 months WMD = 5.10 (1.44, 8.75) P = 0.006, 24 months WMD = 2.47 (_2.01, 6.94) P = 0.28) |
General child development | Benzies et al. 2013 [30] | VIBeS Plus | √ | – | – | Short term 0–24 months |
Goyal et al., 2013 [33] | Home visiting interventions | √ | – | – | Overall effect at infancy, z = 6.98 (p < 0.001) | |
Zhang et al., 2014 [24] | M-MITP, COPE, MITP | √ | – | – | Overall development up to 12 months |