Parent-Guided Developmental Intervention for Infants With Very Low Birth Weight: A Randomized Clinical Trial.

Importance: Early interventions improve neurodevelopmental outcomes after preterm birth, but few studies of early intervention have focused on preterm infants whose families reside in low- or middle-income countries (LMICs). Objective: To evaluate whether parent-guided early intervention improves the neurodevelopmental outcomes of preterm infants in an LMIC. Design, Setting, and Participants: This randomized clinical trial was performed at a high-risk obstetric referral hospital in Brazil, with outcome evaluations by examiners masked to randomization group. Eligibility criteria were (1) birth at the study hospital, (2) residence within 40 km of the birth hospital, and (3) gestational age of less than 32 weeks or birth weight of less than 1500 g. Of 138 enrolled infants, 19 died after randomization and 19 withdrew from the study; all other enrollees (50 per randomization group) were evaluated for the primary outcome. Data were collected from January 1, 2016, to May 31, 2022, and analyzed from June 10 to July 31, 2022. Interventions: On postnatal day 7, infants were randomized to usual care, consisting of support for lactation, kangaroo care, and routine developmental therapies, or to a parent-guided enhanced developmental intervention, consisting of usual care plus infant massage and enhanced visual stimulation, auditory stimulation, social interactions, and support for motor development, instructed by developmental therapists. Main Outcomes and Measures: The primary outcome was the Bayley Scales of Infant and Toddler Development-Third Edition score at 18 months of age adjusted for prematurity. Results: Among the 100 infants included in the analysis, mean (SD) gestational age was 28.4 (2.2) weeks, and 57 (57%) were male. The mean (SD) gestational age for the intervention group was 28.3 (2.3) weeks; for the usual care group, 28.5 (2.2) weeks. Female infants accounted for 21 infants (42%) of the intervention group and 22 (44%) of the usual care group; male infants, 29 (58%) and 28 (56%), respectively. The enhanced developmental intervention group had higher cognitive scores at 18 months of corrected age (mean [SD], 101.8 [11.9] vs 97.3 [13.5]; mean difference, 4.5 [95% CI, 0.1-8.9]). Conclusions and Relevance: In this randomized clinical trial of a parent-guided developmental intervention for early cognitive function of very preterm or very low birth weight infants implemented in an LMIC, the intervention improved very preterm infants' neurodevelopmental outcomes at 18 months of adjusted age. Parent-guided early intervention can improve neurodevelopmental outcome of very preterm infants born in LMICs. Trial Registration: ClinicalTrials.gov Identifier: NCT02835612.

Pai adolescente: percepções de cuidado com o bebê / Adolescent fatherhood: perceptions of baby care

Estudo originado da dissertação de mestrado cujo tema central foi o significado da paternidade na adolescência. Tem como objetivo compreender a forma como pais adolescentes cuidam dos seus filhos, com base na construção da sua masculinidade e a partir de suas experiências de cuidado vividas em sua família de origem. Participaram do estudo sete adolescentes de 17 a 19 anos que vivenciaram a experiência da paternidade e que estiveram com seus bebês internados na Unidade de Internação Neonatal do Hospital de Clínicas de Porto Alegre em 2005. A coleta de informações foi realizada após aprovação do Comitê de Ética da instituição, por meio de entrevista semi-estruturada e observação participativa. Os dados foram submetidos a uma análise de conteúdo, conforme Gomes. Entende-se que o processo de cuidado se inicia nas famílias de origem dos pais adolescentes, refletindo-se nas expectativas de cuidados com os bebês após a alta

This study has derived from a master’s thesis focusing on the meanings of becoming a father during adolescence. It aims at understanding how adolescent fathers take care of their children, based on the construction of their masculinity and on their own care experiences in their families. The subjects of this research were seven adolescents aged between 17-19 years, whose newborns were hospitalized at the Neonatal Unit of Hospital de Clínicas de Porto Alegre in 2005. Data collection was carried out through semi-structured interviews and participative observation, after approval by the Ethics Committee of that institution. Data were submitted to content analysis, according to Gomes. Process of care starts in the adolescent father’s family, then reflecting on care expectations toward their babies after discharge