基层医疗保健提供者在新生儿期开始实施的儿童早期发展干预措施对改善 0-23 月龄儿童认知结局的效果：系统评价和荟萃分析方案。

Effect of early childhood development interventions implemented by primary care providers commencing in the neonatal period to improve cognitive outcomes in children aged 0-23 months: protocol for a systematic review and meta-analysis.

机构信息

Medical School, Division of Paediatrics, University of Western Australia, Perth, Australia.

出版信息

Syst Rev. 2019 Aug 30;8(1):224. doi: 10.1186/s13643-019-1142-1.

DOI:10.1186/s13643-019-1142-1

PMID:31470911

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6716939/

Abstract

BACKGROUND

Impacts of early childhood development (ECD) interventions (such as fostering attachment and responsiveness through communication, play and stimulation) are well known. Globally, there is increasing recognition of the importance of the 'golden' minutes, hours and days after birth for infant health and development. However, only one systematic review has examined ECD interventions implemented in the neonatal period (0-27 days), and this review only assessed interventions implemented by specialised providers. Primary care providers have many potential contacts with mothers and infants throughout the neonatal period. However, it is unclear how many research studies or programmes have examined the effectiveness of ECD interventions commencing in the neonatal period and which methods were used. To date, there has been no systematic review of the effect of ECD interventions delivered by primary care providers commencing in the neonatal period.

METHODS

Our overall aim is to conduct a systematic review of the effect of ECD interventions implemented by primary care providers in the neonatal period. We will assess effects by timing and number ('dose') of contacts with primary care providers. Subgroup assessment will include effects in disadvantaged infants such as those born with low birth weight and to mothers with mental health disorders. We will also assess effects in low- and high-income countries and by type of care provider. The primary outcome is cognitive status in children aged 0-23 months as measured using standardised scales. Secondary outcomes include other child neurodevelopment domains (speech, language, fine motor, gross motor, social, emotional, behaviour, executive functioning, adaptive functioning) in children aged 0-23 months. Effects on maternal mental health will also be assessed between 0-23 months postpartum. Databases such as MEDLINE (OVID), PsycINFO (OVID), EMBASE (OVID), CINAHL, Cochrane Library, WHO databases and reference lists of papers will be searched for relevant articles. Only randomised controlled trials will be included. A narrative synthesis for all outcomes will be reported. Meta-analyses will be performed where exposures and outcomes are sufficiently homogeneous. Guidelines for PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) will be followed.

DISCUSSION

This review appears to be the first to be conducted in this area. The findings will be an important resource for policymakers, primary care providers and researchers who work with young infants in primary care settings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019122021.

摘要

背景

儿童早期发展（ECD）干预措施（如通过沟通、游戏和刺激培养依恋和反应能力）的影响是众所周知的。在全球范围内，人们越来越认识到出生后“黄金”分钟、小时和天对婴儿健康和发育的重要性。然而，只有一项系统评价研究了在新生儿期（0-27 天）实施的 ECD 干预措施，该评价仅评估了由专业提供者实施的干预措施。初级保健提供者在新生儿期与母亲和婴儿有许多潜在的接触机会。然而，目前尚不清楚有多少研究或方案研究了从新生儿期开始的 ECD 干预措施的有效性，以及使用了哪些方法。迄今为止，还没有对初级保健提供者在新生儿期开始实施的 ECD 干预措施效果进行系统评价。

方法

我们的总体目标是对初级保健提供者在新生儿期实施的 ECD 干预措施的效果进行系统评价。我们将根据与初级保健提供者接触的时间和次数（“剂量”）评估效果。亚组评估将包括出生体重低和患有精神健康障碍的母亲所生婴儿等弱势婴儿的效果。我们还将评估在低收入和高收入国家以及不同类型的保健提供者中实施的效果。主要结局是使用标准化量表测量的 0-23 个月儿童的认知状况。次要结局包括 0-23 个月儿童的其他儿童神经发育领域（言语、语言、精细运动、粗大运动、社会、情感、行为、执行功能、适应功能）。产后 0-23 个月时还将评估对产妇心理健康的影响。MEDLINE（OVID）、PsycINFO（OVID）、EMBASE（OVID）、CINAHL、Cochrane 图书馆、世界卫生组织数据库和论文参考文献将被搜索以寻找相关文章。只有随机对照试验将被包括在内。所有结果将进行叙述性综合报告。如果暴露和结局足够同质，将进行荟萃分析。将遵循 PRISMA-P（系统评价和荟萃分析报告的首选条目）指南。