Blaakman Susan W, Borrelli Belinda, Wiesenthal Elise N, Fagnano Maria, Tremblay Paul J, Stevens Timothy P, Halterman Jill S
Department of General Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY; University of Rochester School of Nursing, Rochester, NY.
Department of Psychiatry and Human Behavior, Brown University, and the Miriam Hospital, Centers for Behavioral and Preventive Medicine, Providence, RI.
Acad Pediatr. 2015 Nov-Dec;15(6):605-12. doi: 10.1016/j.acap.2015.05.001. Epub 2015 Jul 22.
Premature infants are at high risk for respiratory disease, and secondhand smoke (SHS) exposure further increases their risk for developing respiratory illness and asthma. Yet, SHS exposure remains problematic in this vulnerable population. Our objective was to evaluate the effects of brief asthma education plus motivational interviewing counseling on reducing SHS exposure and improving respiratory outcomes in premature infants compared to asthma education alone.
Caregivers and their infants ≤32 weeks' gestational age were enrolled after discharge from a neonatal intensive care unit in Rochester, New York, from 2007 to 2011. Participants (N = 165, 61% Medicaid insurance, 35% Black, 19% Hispanic, 59% male) were stratified by infant SHS exposure and randomly assigned to treatment or comparison groups.
Caregivers in the treatment group reported significantly more home smoking bans (96% vs 84%, P = .03) and reduced infant contact with smokers after the intervention (40% vs 58%, P = .03), but these differences did not persist long term. At study end (8 months after neonatal intensive care unit discharge), treatment group infants showed significantly greater reduction in salivary cotinine versus comparison (-1.32 ng/mL vs -1.08 ng/mL, P = .04), but no significant differences in other clinical outcomes.
A community-based intervention incorporating motivational interviewing and asthma education may be helpful in reducing SHS exposure of premature infants in the short term. Further efforts are needed to support sustained protections for this high-risk group and ultimately, prevent acute and chronic respiratory morbidity. Strategies for successfully engaging families during this stressful period warrant attention.
早产儿患呼吸系统疾病的风险很高，接触二手烟（SHS）会进一步增加他们患呼吸系统疾病和哮喘的风险。然而，在这个脆弱群体中，接触二手烟仍然是个问题。我们的目的是评估与单纯哮喘教育相比，简短的哮喘教育加动机性访谈咨询对减少早产儿接触二手烟和改善呼吸结局的效果。
2007年至2011年，在纽约罗切斯特的一家新生儿重症监护病房出院后，招募了孕周≤32周的照顾者及其婴儿。参与者（N = 165，61%为医疗补助保险，35%为黑人，19%为西班牙裔，59%为男性）按婴儿接触二手烟情况分层，并随机分配到治疗组或对照组。
治疗组的照顾者报告称，干预后家庭吸烟禁令显著增多（96%对84%，P = .03），婴儿与吸烟者的接触减少（40%对58%，P = .03），但这些差异未长期持续。在研究结束时（新生儿重症监护病房出院后8个月），治疗组婴儿的唾液可替宁水平较对照组显著降低（-1.32 ng/mL对-1.08 ng/mL，P = .04），但在其他临床结局方面无显著差异。
一项结合动机性访谈和哮喘教育的社区干预措施可能有助于在短期内减少早产儿接触二手烟的情况。需要进一步努力为这个高危群体提供持续保护，最终预防急性和慢性呼吸道疾病。在这个压力较大的时期成功吸引家庭参与的策略值得关注。
