Evaluation of the Development and Implementation of a Multi-Sensory Early Behavioral-Education Intervention for Parents of Extreme Preterm Infants

More than 40,000 infants are born each year in the United States are less than 28 weeks’ gestation at birth.  Nearly three-fourths of these extremely premature infants survive and are discharged home in the care of their families who are often unprepared.  Many of these vulnerable infants are at highest risk for long-term cognitive, behavioral, psycho-emotional, nutritional, and school problems, even in the absence of major neurosensory or motor impairments. Parents need to be able to recognize their baby's behaviors early in their hospitalization and know how to appropriately respond.  Preterm infants are less responsive to interaction, leaving many parents with difficulty predicting and interpreting their infants' needs. Providing parents opportunities to learn and appropriately respond to their babies' behaviors is often hindered by high degrees of parental stress and/or anxiety.  During this time, a parent's readiness to learn, ability to concentrate, retain information, and cognitively process may be limited.   Evidence supports that mothers who quickly engage in the care of their infants in the Newborn ICU tend to be more sensitive to their infants’ cues and have better relationships with them in later years.

Recognizing the need for developing an evidence-based program to provide anticipatory guidance to families and promote parent-infant attachment, members of our multidisciplinary Developmental Care Committee established the EMPOWER© Program. This family-centered program is a multi-sensory developmental care intervention providing parents with the knowledge and skills needed to parent their premature baby.  A pilot program was established with a grant from the Missouri Chapter of the March of Dimes.  Between April 2006 and January 2007, 55 parents of infants between 23-28 weeks’ gestation from a university-based level III NICU were invited to participate in the EMPOWER© Program.  The program, provided over five weeks, is comprised of a three-phase behavioral-educational intervention.  Using a multi-sensory approach, parents of infants between 23-28 weeks’ gestation were given detailed written instruction, DVDs (providing specific infant behaviors and appropriate parenting strategies) and one-on-one developmental care education by a trained specialist. 

Program evaluation included parental stress, anxiety, depression, and beliefs as well as overall program satisfaction.  Results of the evaluation indicate that this parent-directed program supports the belief that parents who know their baby’s specific cues and are able to appropriately respond, may have less depressive mood symptoms, be more active in providing care, and may be better prepared and confident at time of infant discharge.  Recommendations for practice and future research direction will also be discussed.