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Early Intervention Program Improves Health of Babies and Parents

Study shows length of stay in NICU can be reduced significantly

Thursday, November 02, 2006

An educational program for parents of infants born prematurely can improve the health of the child and parents and cut length of hospital stay, according to a study by researchers at the University of Rochester School of Nursing.

The program, when initiated in the first days in a neonatal intensive care unit (NICU), eased stress and enhanced interaction between child and parent. Time in the NICU was reduced by four to eight days, creating significant savings. If the program were implemented nationwide, the researchers estimate the savings could surpass $2 billion.

“A unique aspect of our study is that the program was initiated within two to four days after birth of the premature infant, a period of high stress for parents. Most other programs for parents of premature infants have commenced later in the NICU stay. Our goal was to help parents increase their confidence in knowing what to expect from their premature infants and how to parent their infants during this stressful period,” said Nancy Feinstein, Ph.D., M.S.N., R.N.C., assistant professor at the School of Nursing and co-author of a newly published study of the educational program in the November issue of the journal Pediatrics.

The education program is called Creating Opportunities for Parent Empowerment, or COPE. It was developed by a research team at the School of Nursing led by Bernadette Melnyk, R.N., F.A.A.N., a former professor at the School who now is dean and Distinguished Foundation Professor in Nursing at Arizona State University’s College of Nursing & Healthcare Innovation in Phoenix. Melnyk is the lead author of the Pediatrics article.

The study, a randomized, controlled trial, followed 260 families from 2001 to 2004 in the NICU in Golisano Children’s Hospital at Strong and a NICU in Syracuse. It was funded by the National Institute of Nursing Research, which is part of the National Institutes of Health.

The COPE program includes audiotapes and a parent-child activity workbook. The material focuses on increasing parents’ understanding of the range of behaviors and emotions that premature infants typically display during hospitalization and on developing direct parent participation in a child’s emotional and physical care. The program outlines activities for the parents and child while in the NICU.

Those in the COPE program reported significantly less stress in the NICU and less depression and anxiety than did comparison mothers when their children reached the age of two months (age corrected for prematurity). Mothers and fathers in the program were not known to trained observers, but the observers rated those in the COPE program as more positive in interactions with their infants. Mothers and fathers also reported stronger beliefs about their parental role and what behaviors and characteristics to expect of their infants during hospitalization.

“Given the stressful nature of this experience and the potential impact on health outcomes for the child, parents, and family, it is critical to provide interventions such as COPE to promote improved health outcomes,” Feinstein said.

As the program boosted the confidence of parents and built developmentally sensitive interactions with their infants, hospital staff viewed COPE parents as more ready and able to take their infants home at a younger age than comparison parents. The reductions in stays ranged from four to eight days. The average daily cost of hospitalization in a NICU is approximately $1,250. Based on the 480,000 premature infants born in the United States annually, healthcare savings could total $2.4 billion if the program were implemented as standard practice in neonatal intensive care units, according to the study’s authors.

“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, R.N., F.A.A.N., director of National Institute of Nursing Research.

The researchers are following the children and their parents to determine if the successful outcomes will continue over time through 3 years of age.

In addition to Melnyk and Feinstein, the research team includes: Linda Alpert-Gillis, Ph.D., Eileen Fairbanks, R.N., Hugh Crean, Ph.D., Xin Tu, Ph.D., Leigh Small, R.N., Robert Sinkin, M.D., Steve Gross, M.D., and Pat Stone, Ph.D., R.N.

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