Infants born preterm have an increased risk of subsequent adverse developmental outcomes, and this holds true for the less studied groups of moderate and late preterm infants. To counteract the possible negative developmental trajectories, various early interventions have been designed and implemented to enhance child development and increase parental adjustments.
To assess the effects of one such intervention, a cohort of 118 infants born at Oslo University Hospital between 2005 and 2006 with gestational age between ³ 30.0 and < 36.0 weeks, and hospitalized at the neonatal intensive care unit, were recruited to a randomized controlled trial and followed for 12 months. A comparison group of 52 term-born infants was also recruited. The study examined the effects of the Mother–Infant Transaction Program (MITP), in which a nurse performed early pre- and post-discharge interventions, focusing on both the parent–infant relationship and child development. The MITP is a semi-structured intervention consisting of 11 sessions – seven in-hospital and four home visits – that is based on the theory of mutual transactions in the parent–infant relationship. The aims of the MITP are to enhance child development, to sensitize parents to their infant’s cues and to enhance parental adjustment to the parental role.
Results from this randomized controlled trial showed that mothers in the intervention group had less post-partum depression 1 month after discharge and breast-fed their infants for longer compared with mothers in the control group. The intervention mothers showed increased sensitivity/responsiveness towards their infants, and first-time mothers evinced higher synchronicity in mother–infant dyads. No interventional effect on parenting stress was found, but fathers of preterm infants revealed increased parenting stress compared with fathers of term infants at both 6 and 12 months corrected age.
The present study is a follow-up study at 36 months corrected age with 62 of the same preterm born children and their parents, using both quantitative and qualitative methods. The overall aims of this study were to examine the long-term effects of the MITP and to explore parental experiences of this intervention.
Various aspects of child development were assessed: motor, cognitive, social-emotional and behavioural development. Parenting stress was examined as change over time between 12 and 36 months, and parents’ experiences of stress and concern in raising a preterm-born child more than 36 months after birth were explored. To understand how parents evaluated the MITP, parental satisfaction with the intervention was also investigated.
No long-term effects of the intervention in relation to child development were observed in the present study. Possible explanations are that the programme has less effect on moderate and late preterm infants than on very preterm infants, or that a cumulative effect of the intervention may lead to more obvious effects at a later age. Another possibility is that favourable socio-demographics may counteract the biological adversity set by prematurity. High quality in standard care may also reduce differences between groups, giving them a more equal starting point.
No effect of the intervention on parenting stress, examined as change over time between 12 and 36 months, was observed in the mothers. However, a positive effect on paternal stress was found: the intervention group fathers’ level of parenting stress decreased significantly between 12 and 36 months compared with that of the fathers in the control group. Possible reasons for the effect of the MITP on the intervention fathers but not the mothers may include the increase in paternal opportunities to take care of the 3-year-old child, and that father–child transactions increased both quantitatively and qualitatively. Therefore, better transactions through knowledge, competence and redefinition achieved in the intervention may explain the reduction in parenting stress among intervention fathers.
A qualitative exploration of the influences of the intervention revealed a positive impact of the intervention, despite the lack of reduction in maternal parenting stress. Parents who underwent the intervention reported less stress because they experienced increased confidence, competencies and security as a result of the knowledge, advice, guidance and emotional support given during the intervention. Parents in both groups were vigilant and alert in relation to their child and monitored developmental milestones carefully.
Parents who took part in the MITP evaluated the intervention as an important educational and supportive initiative, reducing stress and enhancing their parental role.