The Impact of an Interactive Guidance Intervention on Sustained Social Withdrawal in Preterm Infants in Chile: Randomized Controlled Trial
Journal
Frontiers in Pediatrics
ISSN
2296-2360
Date Issued
2022
Author(s)
Jorge Bustamante Loyola
Marcela Pérez Retamal
Andrés Mendiburo-Seguel
Antoine Claude Guedeney
Ricardo Salinas González
Lucia Muñoz
Horacio Cox Melane
José Miguel González Mas
Sandra Simó Teufel
Mónica Morgues Nudman
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Background</jats:title><jats:p>Sustained social withdrawal is a key indicator of child emotional distress and a risk factor for psychological development. Preterm infants have a higher probability of developing sustained social withdrawal than infants born full-term during their first year.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To compare the effect of a behavioral guidance intervention to that of routine pediatric care on sustained social withdrawal behavior in preterm infants.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Multicenter randomized clinical trial.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Ninety nine moderate and late preterm newborns and their parents were recruited and randomized into two groups, i.e., Intervention (<jats:italic>n</jats:italic> = 49) and Control (<jats:italic>n</jats:italic> = 50). Both groups attended medical check-ups at 2, 6 and 12 months and were assessed with the Alarm Distress Baby Scale. The intervention group received a standardized behavioral intervention if the neonatologist detected sustained social withdrawal. Also, parents filled out the Edinburgh Postnatal Depression Scale, the modified-Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale-revised.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>At baseline, the prevalence of withdrawal was 4.0% (95% CI: 0.03–14.2) for the control group and 22.4% (95% CI: 13.0–35.9) for the intervention group [OR = 0.22, <jats:italic>p</jats:italic> = 0.028 (95% CI =0.06–0.84)]. At 6 months, the prevalence was 10.0% (95% CI: 3.9–21.8) for the control group and 6.1% (95% CI: 2.1–16.5) for the intervention group [OR = 2.09, <jats:italic>p</jats:italic> = 0.318 (95% CI = 0.49–8.88)]. At 12 months, the prevalence was 22.0% (95% CI: 12.8–35.2) for the control group and 4.1% (95% CI: 1.1–13.7) for the intervention group [OR = 6.63, <jats:italic>p</jats:italic> = 0.018 (95% CI = 1.39–31.71)]. Logistic generalized estimating equation models were performed. The pooled crude OR (considering diagnosis at 6 and 12 months) was 3.54 [<jats:italic>p</jats:italic> = 0.022 (95% CI = 1.20–10.44); Cohen's d= 0.70]. In the case of pooled adjusted OR, the model considered diagnosis (0 = Withdrawal, 1 = Normal) as the dependent variable, time of evaluation (1= 6 months, 2 = 12 months) and group (0 = Control, 1 = Experimental) as factors. In this case, the pooled adjusted OR was 3.57 [<jats:italic>p</jats:italic> = 0.022 (95% CI = 1.20–10.65); Cohen's d = 0.70].</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Assessment and intervention of sustained social withdrawal in preterm infants via standardized instruments benefits families by reducing its prevalence, and possible associated negative outcomes.</jats:p></jats:sec><jats:sec><jats:title>Clinical Trial Registration</jats:title><jats:p>ClinicalTrials.gov; <jats:ext-link>https://clinicaltrials.gov/ct2/show/NCT03212547</jats:ext-link>, identifier: NCT03212547.</jats:p></jats:sec>
Subjects
posttraumatic-stress
;
behavior
;
depression
;
distress
;
precursors
;
symptoms
;
outcomes
;
parents
;
mothers
;
born
;
adult
;
article
;
child
;
chile
;
clinical protocol
;
controlled study
;
dependent variable
;
edinburgh postnatal depression scale
;
emotional stress
;
evaluation study
;
female
;
human
;
impact of events scale
;
interrater reliability
;
major clinical study
;
male
;
multicenter study
;
neonatal intensive care unit
;
neonatologist
;
pediatrics
;
postnatal depression
;
posttraumatic stress disorder
;
prematurity
;
prevalence
;
psychosocial withdrawal
;
questionnaire
;
randomized controlled trial
;
sample size
;
social evolution
;
sustained social withdrawal