Interaction therapy for preterm infants and their parents

Attatchment and interaction between parents and infants are key components in infant development. Parents with preterm infants face challenges that might interfere with parental responsiveness and sensitivity to infant cues. Early preventative interventions that include components promoting responsiveness and positive interaction are used to stimulate development in infants born prematurely.

Reading time approx. 14 minutes Published: January 30, 2020 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Question

What systematic reviews are there on the effects of early interaction interventions on preterm infants and their parents?

Identified literature

**Table 1. Systematic reviews with low/medium risk of bias**
Included studies	Population/Intervention	Outcome
O’Hara et al 2019 [4]
22 studies, 3 on preterm population	Population: Children <5 years old at risk of poor outcomes. N total=1 889 parent-child dyads or family units (n=17 –237), of which n=294 parent-preterm infant dyads Intervention: Video feedback on parental interaction with child	Primary Outcomes: Parental outcomes Parental sensitivity Parental reflective functioning Attachment security Parental stress Parental anxiety Secondary Outcomes: Child outcomes Child mental health Child physical and socioemotional development Child behaviour
Authors' conclusion: “The findings of this review point to moderate-certainty evidence that video feedback may be an effective method of improving maternal sensitivity in a range of mother-infant-dyads. Although we aimed to identify evidence for all children aged 4 years 11 months or under, most included studies focused on infants. The results appear to be consistent across study populations with the exception of two studies, which targeted parents of children at high risk of autism and parents with intellectual disabilities respectively. There was also limited evidence of its use with fathers. There was, in addition, high consistency across the different settings in which video feedback was delivered (e.g. home; community settings such as family centres; and hospital or residential settings.) In terms of practice, these findings suggest that video feedback can be provided to parents with wide-ranging challenges and in almost any setting. The findings do not currently support the use of video feedback to improve any other outcomes (e.g. parental reflective functioning, child behaviour or attachment.”
Spittle et al 2015 [5]
58 articles on 25 studies	Population: Preterm infants <37 weeks gestational age (23–37 weeks or <1000g–2500g) N total =3 615 (n=10 to n=985) Interventions: Early developmental interventions targeting prevention of motor and cognitive impairment, provided post hospital discharge.	Child outcomes Infant cognitive and motor development
Authors' conclusion: “Interventions with a component that focused on the parent-infant relationship had a greater impact on cognitive outcomes at infancy and preschool age when compared with interventions that focused on infant development or parent support alone.” “The current review has demonstrated diminishing effects of early developmental interventions over time. These diminishing effects support the need for further intervention around school age possibly targeted towards school readiness.”
Benzies et al 2013 [1]
18 articles, 15 different interventions	Population: Preterm infants <37 weeks gestational age and/or low birth weight <2 500g; and their parents. N total =3 356 (n=23 to n=985) Intervention: Preventative interventions involving parents and including at least one session in the community (home or clinic).	Parental outcomes Stress Anxiety Depressive symptoms Self-efficacy Sensitivity/responsiveness in interaction with infant
Authors' conclusion: “As a result of early interventions for mothers of preterm infants, positive and clinically meaningful effects were seen for anxiety, depressive symptoms and self-efficacy. To our knowledge, this review was the first to categorize components of early interventions and link them to maternal outcomes. These components were parent psychosocial support, parenting education, and therapeutic developmental support for the infant. Some form or parenting education was used in all interventions. Interventions that included psychosocial support resulted in better outcomes for mothers of preterm infants.” “It is clear that no one intervention component is consistently associated with improved parent outcomes.”
Evans et al 2014 [2]
17 articles on 16 studies, 18 different interventions	Population: Preterm infants <37 weeks gestational age with no major congential abnormalities; and the infants’ mothers. N total =1 940 (n=16 to n=327) Interventions: Parenting interventions where mother-infant relationship quality outcomes are reported.	Mother-Infant relationship Mother-infant dyadic outcomes Maternal relationship outcomes Infant relationship outcomes
Authors' conclusion: “Consistent with attachment theory, this systematic literature review identified that interventions promoting cue-based, responsive care, improves the mother-preterm infant relationship which may enhance the infant’s later development.”
Herd et al 2014 [3]
12 articles on 5 studies, 5 different interventions	Population: Parents of preterm infants with no congenital abnormalities. Birthweight <1000g–2500g or <28 weeks to<36 weeks gestational age. N total =1 654 (n=118 to n=985) Interventions: Preventative parenting interventions designed to enhance parenting skills.	Child behaviour
Authors' conclusion: “Within the 12 articles identified for this systematic review, there were five preterm parenting interventions that assessed child behavior: the IHDP, the MITP, the MITP-M, the Portage Program (from the APIP), and the VIBeS Plus Program. All these studies designated child behavior as a primary or secondary outcome. While the meta-analysis indicated a small, but significant, effect favoring intervention groups, there is some evidence that the IHDP improves behavior up to 3 years of age, the VIBeS Plus program up to 4 years and the MITP-M up to 5 years. There was no evidence that the Portage Program improved child behavior. The VIBes Plus program reported a durable effect on behavior, reporting a medium treatment effect for a reduction in externalizing behavior at 2 years and a small treatment effect at 4 years. The MITP-M (Nordhov et al, 2012) also revealed a durable effect on behavior, reporting a small treatment effect at 2 years and moderate effect at 5 years.” “The MITP-M and the VIBeS Plus Program achieved more durable behavior outcomes using a shorter intervention and lower dosage than did the other preterm parenting interventions.”

References

Benzies KM, Magill-Evans JE, Hayden KA, Ballantyne M. Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2013;13:S10-S10
Evans T, Whittingham K, Sanders M, Colditz P, Boyd RN. Are parenting interventions effective in improving the relationship between mothers and their preterm infants? Infant Behavior and Development 2014;37:131-54.
Herd M, Whittingham K, Sanders M, Colditz P, Boyd RN. Efficacy of preventative parenting interventions for parents of preterm infants on later child behavior: A systematic review and meta-analysis. Infant Ment Health J 2014;35:630-41.
O'Hara L, Smith ER, Barlow J, Livingstone N, Herath NI, Wei Y, et al. Video feedback for parental sensitivity and attachment security in children under five years. Cochrane Database Syst Rev 2019;11:CD012348.
Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2015;2015.

Literature search

**MedLine via Ovid 191022**
**Interaction therapy for preterm infants**
.ab. = Abstract; .ti. = Title; .kw. = Keyword; exp = Term form the MedLine controlled vocabulary, including terms found below this term in the MeSH hierarchy; / = Term from the MedLine controlled vocabulary; * or $ = Truncation (if found at the end of a free text term)
Search terms		Items found
Population:
1.	exp Infant, Premature/
2.	Premature Birth/
3.	Infant, Premature, Diseases/
4.	Infant, Low Birth Weight/
5.	exp Infant, Very Low Birth Weight/
6.	Intensive Care, Neonatal/
7.	Intensive Care Units, Neonatal/
8.	((premature or preterm) adj3 (infant* or baby or child* or newborn or neonate* or birth*)).ab,kw,ti
9.	prematurity.ab,kw,ti
10.	or/1-9	136 298
Intervention:
11.	exp Family Relations/
12.	Object Attachment/
13.	Early Intervention/
14.	"infant cue*".ab,kw,ti.
15.	((developmental or family) adj3 care).ab,kw,ti.
16.	(parent* adj6 (sensitiv* or responsiv* or program*)).ab,kw,ti.
17.	((attachment or interaction) adj6 (intervention* or program* or therapy)).ab,kw,ti.
18.	or/11-17
19.	((mother* or father* or parent) adj3 infant).ab,kw,ti.
20.	(intervention* or interaction or therapy or psychotherapy).ab,kw,ti.
21.	19 and 20
22.	18 or 21	127 456
Study types:
23.	systematic review/
24.	meta-analysis/
25.	(((systematic* adj3 (review or overview)) or meta analysis or metaanalysis).ab,kw,ti.
26.	Or/23-25	261 182
Combined sets:
27.	10 and 22 and 26	164
Final		164

**Embase via embase.com 191022**
**Interaction therapy for preterm infants**
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Search terms		Items found
Population:
1.	‘prematurity’/exp
2.	‘low birth weight’/exp
3.	‘newborn care’/exp
4.	‘neonatal intensive care unit’/de
5.	prematurity:ti,ab,kw
6.	((premature OR preterm) NEAR/3 (infant* OR baby OR child* OR newborn OR neonate* OR birth*)):ti,ab,kw
7.	1 OR 2 OR […] 6	215 706
Intervention:
8.	‘parent counseling’/de
9.	‘child parent relation’/exp
10.	((developmental OR family) NEAR/2 care):ti,ab,kw
11.	(parent* NEAR/5 (sensitiv* OR responsiv* OR program*)):ti,ab,kw
12.	‘infant cue*’:ti, ab,kw
13.	((attachment or interaction) NEAR/5 (intervention* OR program* OR therapy));ti,ab,kw
14.	((mother* OR father* OR parent) NEAR/2 infant):ti,ab.kw
15.	(intervention* OR interaction OR therapy OR psychotherapy);ti,ab,kw
16.	14 AND 15
17.	8 OR 9 OR […] 13 OR 16	109 189
Study types:
18.	‘systematic review’/de
19.	‘meta analysis’/exp
20.	(systematic* NEAR/3 (review OR overview)):ti,ab,kw
21.	(‘meta analysis’ OR metaanalysis):ti,ab,kw
22.	18 OR 19 OR 20 OR 21	397 986
Combined sets:
23.	7 AND 17 AND 22	208
Final		208

**Scopus via scopus.com 191022**
**Interaction therapy for preterm infants**
TITLE-ABS-KEY = Title or abstract or keywords; ALL = All fields; PRE/n = "precedes by". The first term in the search must precede the second by a specified number of terms (n).; W/n = "within". The terms in the search must be within a specified number of terms (n) in any order.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; LIMIT-TO ( SRCTYPE , "j" = Limit to source type journal; LIMIT-TO ( DOCTYPE , "ar" = Limit to document type article; LIMIT-TO ( DOCTYPE , "re" = Limit to document type review
Search terms		Items found
Population:
1.	TITLE-ABS-KEY(prematurity OR ((premature OR preterm) W/3 (infant OR baby OR child OR newborn OR neonate OR birth)))	148 728
Intervention:
2.	TITLE-ABS-KEY(((developmental OR family) W/2 care) OR “infant cues” OR (parent* W/5 (sensitivi* OR responsive* OR program)) OR (((mother OR father OR parent) W/2 infant) AND (intervention OR interaction OR therapy OR psychotherapy)) OR ((attachment OR interaction) W/5 (interention OR program OR therapy)))	41 406
Study types:
3.	TITLE-ABS-KEY((systematic* W/2 (review OR overview)) OR “meta analysis” OR metaanalysis)	415 714
Combines sets:
4.	1 AND 2 AND 3	144
Final		144

**CIHAHL via Ebsco 191022**
**Interaction therapy for preterm infants**
The search result, usually found at the end of the documentation, forms the list of abstracts.; AB = Abstract; AU = Author; MH = Exact Subject Heading; MM = Major Concept; SU = Subject; TI = Title; TX = All Text; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms		Items found
Population:
1.	MH “Intensive Care, Neonatal+”
2.	MH “Neonatal Intensive Care Nursing”
3.	MH “Intensive Care Units, Neonatal”
4.	MH “Infant, Premature”
5.	MH “Infant, Low Birth Weight”
6.	MH “Infant, Very Low Birth Weight”
7.	TI prematurity OR AB prematurity OR SU prematurity
8.	TI ( ((premature OR preterm) N2 (infant* OR baby OR child* OR newborn OR neonate* OR birth) ) OR AB ( ((premature OR preterm) N2 (infant OR baby OR child* OR newborn OR neonate* OR birth) ) OR SU ( ((premature OR preterm) N2 (infant OR baby OR child* OR newborn OR neonate* OR birth*) )
9.	1 OR 2 OR […] 8	55 600
Intervention:
10.	MH “Family Relations+”
11.	MH “Early Childhood Intervention”
12.	TI "infant cue" OR AB "infant cue" OR SU "infant cue*"
13.	TI ( ((developmental OR family) N2 care) ) OR AB ( ((developmental OR family) N2 care) ) OR SU ( ((developmental OR family) N2 care) )
14.	TI ( (parent* N5 (intervention* OR sensitivity OR responsiv* OR program)) ) OR AB ( (parent N5 (intervention* OR sensitivity OR responsiv* OR program)) ) OR SU ( (parent N5 (intervention* OR sensitivity OR responsiv* OR program*)) )
15.	TI ( ((mother* OR father* OR parent) N2 infant) AND (intervention* OR interaction OR therapy OR psychotherapy) ) OR AB ( ((mother* OR father* OR parent) N2 infant) AND (intervention* OR interaction OR therapy OR psychotherapy) ) OR SU ( ((mother* OR father* OR parent) N2 infant) AND (intervention* OR interaction OR therapy OR psychotherapy) )
16.	TI ( ((attachment OR interaction) N5 (intervention* OR program* OR therapy)) ) OR AB ( ((attachment OR interaction) N5 (intervention* OR program* OR therapy)) ) OR SU ( ((attachment OR interaction) N5 (intervention* OR program* OR therapy)) )
17.	10 OR 11 OR […] 16	91 876
Study types:
18.	MH “Literature Review+”
19.	MH “Meta Analysis”
20.	TI ( (systematic* N2 (review OR overview)) OR "meta analysis" OR metaanalysis ) OR AB ( (systematic* N2 (review OR overview)) OR "meta analysis" OR metaanalysis ) OR SU ( (systematic* N2 (review OR overview)) OR "meta analysis" OR metaanalysis )
21.	18 OR 19 OR 20	156 690
Combined set:
22.	9 AND 17 AND 21	208
Final		208

**PsycInfo via ebsco.com 191022**
**Interaction therapy foro preterm infants**
The search result, usually found at the end of the documentation, forms the list of abstracts
Search terms		Items found
Population:
1.	DE “Premature Birth”
2.	DE “Birth Weight”
3.	DE “Neonatal Intensive Care”
4.	DE “Neonatal Disorders”
5.	TI prematurity OR AB prematurity OR SU prematurity
6.	TI ( ((premature OR preterm) N2 (infant* OR baby OR child* OR newborn OR neonate* OR birth) ) OR AB ( ((premature OR preterm) N2 (infant OR baby OR child* OR newborn OR neonate* OR birth) ) OR SU ( ((premature OR preterm) N2 (infant OR baby OR child* OR newborn OR neonate* OR birth*) )
7.	1 OR 2 OR […] 6	13 435
Intervention:
8.	DE “Family Intervention”
9.	DE “Parent Child Relations”
10.	DE “Attachment Behavior”
11.	TI “infant cue” OR AB “infant cue” OR SU “infant cue*”
12.	TI ( (parent* N5 (sensitiv* OR responsiv* OR program)) ) OR AB ( (parent N5 (sensitiv* OR responsiv* OR program)) ) OR SU ( (parent N5 (sensitiv* OR responsiv* OR program*)) )
13.	TI ( ((mother* OR father* OR parent) N2 infant) AND (intervention* OR interaction OR therapy OR psychotherapy) ) OR AB ( ((mother* OR father* OR parent) N2 infant) AND (intervention* OR interaction OR therapy OR psychotherapy) ) OR SU ( ((mother* OR father* OR parent) N2 infant) AND (intervention* OR interaction OR therapy OR psychotherapy) )
14.	TI ( ((attachment OR interaction) N5 (intervention* OR program* OR therapy)) ) OR AB ( ((attachment OR interaction) N5 (intervention* OR program* OR therapy)) ) OR SU ( ((attachment OR interaction) N5 (intervention* OR program* OR therapy)) )
15.	8 OR 9 OR […] 14	83 752
Study types:
16.	DE “Systematic Review”
17.	DE “Meta Analysis”
18.	TI ( (systematic* N2 (review OR overview)) OR “meta analysis” OR metaanalysis) OR AB ( (systematic* N2 (review OR overview)) OR “meta analysis” OR metaanalysis) OR SU ( (systematic* N2 (review OR overview)) OR “meta analysis” OR metaanalysis)
19.	16 OR 17 OR 18	53 418
Combined set:
20.	7 AND 15 AND 19	35
Final		35

Page published January 30, 2020