Puthussery Shuby, Chutiyami Muhammad, Tseng Pei-Ching, Kilby Lesley, Kapadia Jogesh
Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
Neonatal Unit, Luton and Dunstable Hospital, Lewsey Rd, Luton, LU4 0DZ, UK.
BMC Pediatr. 2018 Jul 9;18(1):223. doi: 10.1186/s12887-018-1205-9.
Various intervention programs exist for parents of preterm babies and some systematic reviews (SRs) have synthesised the evidence of their effectiveness. These reviews are, however, limited to specific interventions, components, or outcomes, and a comprehensive evidence base is lacking. The aim of this meta-review was to appraise and meta-synthesise the evidence from existing SRs to provide a comprehensive evidence base on the effectiveness of interventions for parents of preterm infants on parental and infant outcomes.
We conducted a comprehensive search of the following databases to identify relevant SRs: Cochrane library, Web of science, EMBASE, CINAHL, British Nursing Index, PsycINFO, Medline, ScienceDirect, Scopus, IBSS, DOAJ, ERIC, EPPI-Centre, PROSPERO, WHO Library. Additional searches were conducted using authors' institutional libraries, Google Scholar, and the reference lists of identified reviews. Identified articles were screened in two stages against an inclusion criteria with titles and abstracts screened first followed by full-text screening. Selected SRs were appraised using the AMSTAR tool. Extracted data using a predesigned tool were synthesised narratively examining the direction of impact on outcomes.
We found 11 SRs eligible for inclusion that synthesised a total of 343 quantitative primary studies. The average quality of the SRs was 'medium'. Thirty four interventions were reported across the SRs with considerable heterogeneity in the structural framework and the targeted outcomes that included maternal-infant dyadic, maternal/parental, and infant outcomes. Among all interventions, Kangaroo Care (KC) showed the most frequent positive impact across outcomes (n = 19) followed by Mother Infant Transaction Program (MITP) (n = 14). Other interventions with most consistent positive impact on infant outcomes were Modified-Mother Infant Transaction Program (M-MITP) (n = 6), Infant Health and Development Program (IHDP) (n = 5) and Creating Opportunities for Parent Empowerment (COPE) (n = 5). Overall, interventions with both home and facility based components showed the most frequent positive impact across outcomes.
Neonatal care policy and planning for preterm babies should consider the implementation of interventions with most positive impact on outcomes. The heterogeneity in interventions and outcomes calls for the development and implementation of an integrated program for parents of preterm infants with a clearly defined global set of parental and infant outcomes.
针对早产儿父母有各种干预项目，一些系统评价（SRs）综合了其有效性的证据。然而，这些评价仅限于特定的干预措施、组成部分或结果，缺乏全面的证据基础。本元评价的目的是评估和综合现有系统评价的证据，以提供关于早产儿父母干预措施对父母和婴儿结局有效性的全面证据基础。
我们对以下数据库进行了全面检索，以识别相关的系统评价：Cochrane图书馆、科学网、EMBASE、CINAHL、英国护理索引、PsycINFO、Medline、ScienceDirect、Scopus、IBSS、DOAJ、ERIC、EPPI中心、PROSPERO、世界卫生组织图书馆。还使用作者所在机构的图书馆、谷歌学术以及已识别评价的参考文献列表进行了额外检索。根据纳入标准分两个阶段对识别出的文章进行筛选，首先筛选标题和摘要，然后进行全文筛选。使用AMSTAR工具对选定的系统评价进行评估。使用预先设计的工具提取的数据进行叙述性综合，考察对结局的影响方向。
我们发现11项符合纳入标准的系统评价，共综合了343项定量的原始研究。系统评价的平均质量为“中等”。各项系统评价共报告了34种干预措施，在结构框架和目标结局方面存在相当大的异质性，包括母婴二元结局、母亲/父母结局和婴儿结局。在所有干预措施中，袋鼠式护理（KC）在各项结局中显示出最频繁的积极影响（n = 19），其次是母婴互动项目（MITP）（n = 14）。对婴儿结局最具一致性积极影响的其他干预措施包括改良母婴互动项目（M-MITP）（n = 6）、婴儿健康与发展项目（IHDP）（n = 5）和增强父母权能创造机会项目（COPE）（n = 5）。总体而言，同时包含家庭和机构组成部分的干预措施在各项结局中显示出最频繁的积极影响。
早产儿的新生儿护理政策和规划应考虑实施对结局有最积极影响的干预措施。干预措施和结局的异质性要求为早产儿父母制定和实施一个综合项目，明确一套全球通用的父母和婴儿结局。
