护士家访对改善母婴产前至两岁儿童结局的效果：一项随机对照试验（不列颠哥伦比亚省健康连接项目）。

Effectiveness of nurse-home visiting in improving child and maternal outcomes prenatally to age two years: a randomised controlled trial (British Columbia Healthy Connections Project).

机构信息

Simon Fraser University, Vancouver, BC, Canada.

McMaster University, Hamilton, ON, Canada.

出版信息

J Child Psychol Psychiatry. 2024 May;65(5):644-655. doi: 10.1111/jcpp.13846. Epub 2023 Jul 19.

DOI:10.1111/jcpp.13846

PMID:37464862

Abstract

BACKGROUND

We investigated the effectiveness of Nurse-Family Partnership (NFP), a prenatal-to-age-two-years home-visiting programme, in British Columbia (BC), Canada.

METHODS

For this randomised controlled trial, we recruited participants from 26 public health settings who were: <25 years, nulliparous, <28 weeks gestation and experiencing socioeconomic disadvantage. We randomly allocated participants (one-to-one; computer-generated) to intervention (NFP plus existing services) or comparison (existing services) groups. Prespecified outcomes were prenatal substance exposure (reported previously); child injuries (primary), language, cognition and mental health (problem behaviour) by age two years; and subsequent pregnancies by 24 months postpartum. Research interviewers were masked. We used intention-to-treat analyses. (ClinicalTrials.gov, NCT01672060.) RESULTS: From 2013 to 2016 we enrolled 739 participants (368 NFP, 371 comparison) who had 737 children. Counts for child injury healthcare encounters [rate per 1,000 person-years or RPY] were similar for NFP (223 [RPY 316.17]) and comparison (223 [RPY 305.43]; rate difference 10.74, 95% CI -46.96, 68.44; rate ratio 1.03, 95% CI 0.78, 1.38). Maternal-reported language scores (mean, M [SD]) were statistically significantly higher for NFP (313.46 [195.96]) than comparison (282.77 [188.15]; mean difference [MD] 31.33, 95% CI 0.96, 61.71). Maternal-reported problem-behaviour scores (M [SD]) were statistically significantly lower for NFP (52.18 [9.19]) than comparison (54.42 [9.02]; MD -2.19, 95% CI -3.62, -0.75). Subsequent pregnancy counts were similar (NFP 115 [RPY 230.69] and comparison 117 [RPY 227.29]; rate difference 3.40, 95% CI -55.54, 62.34; hazard ratio 1.01, 95% CI 0.79, 1.29). We observed no unanticipated adverse events.

CONCLUSIONS

NFP did not reduce child injuries or subsequent maternal pregnancies but did improve maternal-reported child language and mental health (problem behaviour) at age two years. Follow-up of long-term outcomes is warranted given that further benefits may emerge across childhood and adolescence.

摘要

背景

我们研究了产前至两岁的家庭访视项目——护士家庭伙伴关系（NFP）在加拿大不列颠哥伦比亚省（BC）的有效性。

方法

这项随机对照试验招募了来自 26 个公共卫生机构的参与者，他们的情况是：<25 岁，初产妇，<28 周妊娠，经济社会地位不利。我们将参与者（一对一；计算机生成）随机分配到干预（NFP 加现有服务）或对照组（现有服务）组。预先规定的结果是产前物质暴露（以前报告过）；儿童伤害（主要）、语言、认知和心理健康（问题行为）在两岁时；以及 24 个月产后的后续妊娠。研究采访者是盲目的。我们采用意向治疗分析。（ClinicalTrials.gov，NCT01672060。）

结果

2013 年至 2016 年，我们招募了 739 名参与者（NFP 368 名，对照组 371 名），他们有 737 名儿童。儿童伤害医疗保健遭遇次数（每千人/人年或 RPY 的发生率）NFP（223 [RPY 316.17]）和对照组（223 [RPY 305.43]）相似；差异发生率为 10.74，95%可信区间为-46.96，68.44；率比为 1.03，95%可信区间为 0.78，1.38。NFP 组（M [SD]）的母亲报告语言分数（313.46 [195.96]）明显高于对照组（282.77 [188.15]）；平均差异（MD）为 31.33，95%可信区间为 0.96，61.71。NFP 组（M [SD]）的母亲报告问题行为评分（52.18 [9.19]）明显低于对照组（54.42 [9.02]）；MD-2.19，95%可信区间为-3.62，-0.75。后续妊娠次数相似（NFP 115 [RPY 230.69]和对照组 117 [RPY 227.29]）；差异发生率为 3.40，95%可信区间为-55.54，62.34；风险比为 1.01，95%可信区间为 0.79，1.29。我们没有观察到意外的不良事件。