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Healthier preemies and parents, thanks to a new early intervention program

November 02, 2006

A program designed to help parents care for their premature infants in the neonatal intensive care unit (NICU) can lead to healthier babies and parents, and save more than $2 billion in U.S. healthcare costs annually.

A new study published in the November issue of the journal Pediatrics shows that an educational-behavioral program called Creating Opportunities for Parent Empowerment (COPE) can improve the mental health of parents and decrease the length of stay in the NICU by four to eight days for premature infants.

Based on the 480,000 premature infants born in the United States annually, potential healthcare savings could total $2.4 billion if the program were implemented as standard practice in NICUs, according to the study's authors. The average per day hospitalization cost for infants in the NICU is approximately $1,250.

"Prior evidence suggests low-birth-weight infants experience adverse physical, mental and behavioral outcomes that persist beyond school age," says the study's lead author, Bernadette Melnyk, RN, FAAN, dean and Distinguished Foundation Professor in Nursing at Arizona State University's College of Nursing & Healthcare Innovation. "Parents of preterm infants also experience high stress levels and are usually inadequately prepared for the experience. When parents are stressed, anxious or depressed the result is increased rates of dysfunctional and over-protective parenting."

Interventions to enhance coping and mental health outcomes in parents or premature infants have lagged behind the rapid technological advances to sustain survival in the NICUs, adds Melnyk.

The National Institutes of Health/National Institute of Nursing Research funded the study. It involved a randomized clinical trial from 2001 to 2004 conducted with 260 families with preterm infants in two NICUs in the northeast United States.

All families received four intervention sessions of audiotape and written materials. Parents in the COPE program received information and behavioral activities about the appearance and behavioral characteristics of preterm infants and how best to parent them.

An educational/behavioral intervention was used because information reinforced with behavioral activities has been shown to be more effective in producing change than information alone, the authors report.

"A key finding crucial to the program's success was that COPE was launched shortly after admission to the NICU, two to four days after birth," said Melnyk, "Most prior programs for parents of premature infants have started weeks after admission to the NICU, which allows time for parents to develop negative perceptions of their infants and a lack of confidence in how to parent them."

In addition to COPE parents reporting less stress in the NICU and interacting with their infants in a more developmentally sensitive manner than comparison group parents, the study found that COPE mothers had significantly fewer anxiety and depressive symptoms when their infants were two months of age.

Both mothers' and fathers' parenting beliefs/confidence and how they interacted with their infants in the NICU were related to a shorter length of stay.

Post study discussions were held with unit neonatal healthcare teams involved in discharge planning of all NICU babies. These teams indicated that criteria for discharge not only includes that the preterm is physiologically stable, but that the parents are ready to assume care for their infants.

As a result of stronger beliefs/confidence and more developmentally sensitive interaction with their infants, staff perceived COPE parents to be more ready and able to take their infants home at an earlier gestational age than comparison parents.

This study demonstrates the important role that nurse scientists can play not only in helping families cope during a highly stressful period in their lives, but also in contributing to a family's long-term quality of life and well being, said Patricia Grady, RN, FAAN, director of National Institute of Nursing Research.

Continued study of these infants, through three years of age, and their parents is underway to determine the long-term effects of the COPE program. While the current study demonstrates considerable cost savings during the NICU stay, sustainable long-term effects could result in additional savings to a burdened health care system.

Arizona State University