PRETERM INFANT FOLLOW-UP PROJECT - A MULTISITE FIELD EXPERIMENT OF HOSPITAL AND HOME INTERVENTION PROGRAMS FOR MOTHERS AND PRETERM INFANTS

This study was designed as a multi-site field experiment to test the e fficacy of hospital and home visit interventions to improve interactio n between mothers and preterm infants. Hospital intervention consisted of State Modulation (SM) treatment, which focused on teaching mothers to read the behavioral cues and modulate the states of consciousness of preterm infants during feedings. Home visit intervention was a fiel d-tested program, Nursing Systems for Effective Parenting-Preterm (NST EP-P), implemented during the first five months after the infant's hos pital discharge. A hospital program on car seats (CS) and standard pub lic health nursing home visits (PHN) served as comparison treatments. The sample consisted of 327 mothers and their preterm infants who were less than 36 weeks of gestational age at hospital discharge. Mothers were randomly assigned to intervention groups on the basis of their ed ucation. High education (HE) was greater than or equal to 13 years of education, while low education (LE) was less than or equal to 12 years of education. HE mothers were only assigned to hospital programs, whi le LE mothers were assigned to combinations of hospital and home visit programs. Evaluations were conducted at 40 weeks conceptual age (expe cted date of birth), at 46 weeks conceptual age (1.5-months-corrected age), and 60 weeks conceptual age (5-months-corrected age). Comparison s were made within each educational group. For HE groups, SM infants g ave significantly more clear cues during observations of feeding inter actions at 1.5-months-corrected age and teaching interactions at 5-mon ths-corrected age than infants in the CS group. During the teaching in teraction, well-educated SM mothers provided significantly more social -emotional and cognitive stimulation than CS mothers. For LE groups, i nfants in the SM group combined with either PHN or NSTEP-P exhibited s ignificantly more responsive behavior during feeding observations than those infants in the CS/PHN group at 1.5-months-corrected age. LE mot hers in the SM/NSTEP-P group demonstrated more sensitivity and more st imulation during teaching interactions at 5-months-corrected age than mothers in the SM/PHN or CS/PHN groups. Findings suggest that State Mo dulation treatment is effective in influencing positive social interac tion of infants regardless of the level of maternal education. State m odulation treatment combined with NSTEP-P is most effective in improvi ng the social interaction between preterm infants and mothers with lim ited formal education. Such treatment-specific programs suggest avenue s for providing cost-effective care that complements the changing tran sactional needs of mothers and preterm infants.