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Smedler, Ann-Charlotte
Publications (10 of 47) Show all publications
Baraldi, E., Westling Allodi, M., Smedler, A.-C., Löwing, K., Westrup, B., Wadström, N. & Ådén, U. (2024). Innovative multiprofessional early intervention aiming at improving development of prematurely born children. In: : . Paper presented at Conference on Reasearch Innovations in Early Interventions (CRIEI), San Diego, USA, 15-17 February, 2024..
Open this publication in new window or tab >>Innovative multiprofessional early intervention aiming at improving development of prematurely born children
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2024 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Abstract: Extremely preterm born children and their parents is a vulnerable group with a high risk of developmental delays, academic challenges and parental mental health difficulties. Previously interventions have been medical focusing of increasing survival, but recently post-discharge interventions improving long-term development have been presented. This abstract concerns a novel multiprofroessional intervention, Stockholm Preterm Interaction-Based Intervention (SPIBI) aiming at consolidation of expertise from educational, behavioral and medical fields in benefit of the child development and family well-being.  

Rationale and purpose: SPIBIs purpose is to enhance the parent-child interaction, child cognitive and motor development, child preschool social participation and parental mental health in families with extreme preterm born infants.

Description of methods, results, or modes of inquiry: In a novel RCT a strengths-based post-discharge intervention targeting extreme preterm born (EPT= born before 28 gestational weeks) infants and their parents is being tested. 130 EPT born children and their parents have been randomly allocated to an intervention group receiving 10 home visits during the first year at home, or a control group receiving treatment as usual with an extended follow-up program. The novel intervention is named Stockholm Preterm Interaction-Based Intervention (SPIBI).

Innovation: The field of long-term development of extremely born infants is innovative in itself, since the field consist of a severely vulnerable population on the verge of viability, who did not survive twenty years ago. The innovation in SPIBI is its consolidation of practical knowledge as well as research concerning the challenges of extreme prematurity from a medical (brain developmental), special educational (preschool behavioral), physiotherapeutic (motor), psychological (parent-child-interactional and cognitive) perspective. Working together will benefit the child and family as a whole, since extreme prematurity is a nuanced field with implications for several aspects of development. Despite this, previous international research from the field is almost always unidisciplinary.

Implications for policy or practice: The outcome will influence practice at a regional and possible national level, concerning how a low cost early intervention may improve several outcomes and reduce challenges for a group of children with a high risk of developmental delays.

Relationship to principles of diversity, equity, and inclusion: The extreme preterm born population often has double challenges, both concerning developmental delays and socioeconomic hardships, both internationally and in a Swedish context. Giving this vulnerable population initial extra support is ultimately a question of equity, increasing the chance of participating in fully inclusive learning environments ahead.

Methods used to encourage audience engagement When presenting the poster, these 3 questions will be continuously discussed with researchers passing by:

1.     What do parents to medically fragile infants who have been balancing on the verge of death, need when the family comes back home from the hospital?

2.     What are the key elements of multidisciplinary and multiprofessional co-operation between medicine, psychology and special education?

3.     What may be the different needs of different groups of families with extreme preterm born children, regarding socioeconomic background, severity of prematurity and migration statues?

Keywords
Infant and toddler/Family, Multiprofessional
National Category
Pedagogy
Research subject
Special Education
Identifiers
urn:nbn:se:su:diva-226838 (URN)
Conference
Conference on Reasearch Innovations in Early Interventions (CRIEI), San Diego, USA, 15-17 February, 2024.
Projects
Stockholm Interaction-Based Intervention
Available from: 2024-02-21 Created: 2024-02-21 Last updated: 2024-02-23Bibliographically approved
Baraldi, E., Wadström, N., Westling Allodi, M., Smedler, A.-C., Örtqvist, M., Löwing, K. & Ådén, U. (2023). Stockholm Preterm Interaction-based Intervention (SPIBI) – Av RCT Assessing Parent-Infant Interaction at 12 Months Corrected Age in Extremely Preterm Born Infants and Their Parents. In: : . Paper presented at jENS 2023: 5th Congress of joint European Neonatal Societies, 19-23 September 2023, Rome, Italy..
Open this publication in new window or tab >>Stockholm Preterm Interaction-based Intervention (SPIBI) – Av RCT Assessing Parent-Infant Interaction at 12 Months Corrected Age in Extremely Preterm Born Infants and Their Parents
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2023 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background

Parental responsiveness is of great importance for positive effects of behavioral and cognitive development in preterm infants and the Emotional availability scales (EAS) is a clinically relevant assessment measure, for early neurodevelopment. The EAS is an observational measure which reflects the quality of parent–child relationship and the child’s socio-emotional development. It has 4 adult domains (sensitivity, structuring, non-intrusiveness, non-hostility) and 2 child domains (responsiveness, involvement) (Biringen 2014). In an ongoing RCT of an intervention for extremely preterm (EPT) born infants and their parents, the Stockholm Preterm Interaction-Based Intervention (SPIBI), the primary outcome measure is EAS used at 12 months corrected age (CA). The aim for this sub-study is to evaluate the inter-rater reliability of EAS in this cohort.

Method

During the first year after discharge, ten home visits were carried out from specially educated interventionists of our multidisciplinary team. 130 EPT infants were recruited and 115 have been filmed and assessed at 12 months CA. The parent was instructed to play with the infant for 10 minutes. Dyads were filmed, videos assessed and scored by a trained EAS-accredited team member. 20% of the videos (23/115) were assessed by an additional EAS-accreditor to evaluate inter-rater-reliability. Interclass Correlation Coefficient (ICC) were used. To obtain authenticity with real-life, the videos were filmed in a home setting with opportunity to choose study parent. Interaction were encouraged to proceed in an ordinary pattern.

Results

ICC values range 0,86 - 0,96 within all dimensions, all individual values, 95%CI (Table 1). This indicates high inter-rater reliability, although some of the subscales had lower ICC (0,73-0,98). 

Conclusion

The SPIBI study corresponds well with EAS scoring assessment method for reflection of parent-infant interaction at 12 months CA in EPT born infants.

Keywords
preterm infants, parental responsiveness, early neurodevelopment, Emotional availability scales, Stockholm Preterm Interaction-Based Intervention
National Category
Pediatrics Psychology
Research subject
medicinsk beteendevetenskap; Psychology
Identifiers
urn:nbn:se:su:diva-221440 (URN)
Conference
jENS 2023: 5th Congress of joint European Neonatal Societies, 19-23 September 2023, Rome, Italy.
Available from: 2023-09-20 Created: 2023-09-20 Last updated: 2024-01-11Bibliographically approved
Baraldi, E., Westling Allodi, M., Smedler, A.-C., Löwing, K., Westrup, B. & Ådén, U. (2022). Insights Gained from Stockholm Preterm Interaction-Based Intervention - A Critical View. In: : . Paper presented at ISEI International Society on Early Intervention Conference, 27-30, September, Chicago, USA.
Open this publication in new window or tab >>Insights Gained from Stockholm Preterm Interaction-Based Intervention - A Critical View
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2022 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

SPIBI is a strength-based early intervention targeting parent-child interaction amongst extremely preterm born infants, currently tested in an RCT in Sweden. Of 130 infants, 72% have reached 12 months of age. Based on interviews with 17 parents’ and 6 intervention providers we identified SPIBI strengths and shortcomings. SPIBI seems feasible, is possible to integrate it into home-visiting practice and is appreciated by parents. Identified challenges are geographical distance; recruitment obstacles including Covid-19, leading to longer-term implementation; service-provider fatigue; and social adversities amongst some eligible participants requiring ethical considerations. Future improvements include: reconsidering inclusion criteria, increasing use of e-health, and exploring the possibility of a tiered approach.

National Category
Psychology Pedagogy
Research subject
Special Education
Identifiers
urn:nbn:se:su:diva-210029 (URN)
Conference
ISEI International Society on Early Intervention Conference, 27-30, September, Chicago, USA
Available from: 2022-10-04 Created: 2022-10-04 Last updated: 2023-01-27
Eninger, L., Ferrer-Wreder, L., Eichas, K., Olsson, T. M. M., Ginner Hau, H., Westling Allodi, M., . . . Herkner, B. (2021). A Cluster Randomized Trial of Promoting Alternative Thinking Strategies (PATHS®) With Swedish Preschool Children. Frontiers in Psychology, 12, Article ID 695288.
Open this publication in new window or tab >>A Cluster Randomized Trial of Promoting Alternative Thinking Strategies (PATHS®) With Swedish Preschool Children
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2021 (English)In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 12, article id 695288Article in journal (Refereed) Published
Abstract [en]

The preschool edition of Promoting Alternative THinking Strategies (PATHS(R)) is a school-based, teacher implemented universal intervention developed in the United States designed to promote social emotional competence (SEC) in children as a foundation for improved mental health. PATHS is delivered as a curriculum and it is based on theories and research regarding SEC, brain development, and optimal school environments. A majority of children in Sweden attend preschool, which is government-subsidized and follows a national curriculum focusing on both academic and social emotional learning. However, there is not so much focus on formal instruction nor manual-based lessons. The purpose of this study was to assess the short-term (pre- to post-test) effects of PATHS in the Swedish preschool setting. Using a two-wave cluster randomized trial with multi-method and informant assessment (N = 285 4 and 5-year-old Swedish children; n = 145 wait-list control; n = 140 intervention; K = 26 preschools; k = 13 intervention; k = 13 control) we assessed changes in child emotional knowledge, emotional awareness, social problem solving, prosocial play, inhibitory control, and working memory using structural equation modeling (SEM). We included schools with at least one classroom of 4-5-year-old children from three municipalities. We excluded open preschools, parent cooperative preschools, and family day homes. After random assignment, schools were informed of condition assignment. Research team members were not blind to assignment. We hypothesized that relative to children in control schools, children in intervention schools would evidence improvements in social emotional competence as well as other outcomes. Children in PATHS, relative to children in the control, evidenced improvements in working memory and prosocial play, but also showed an increase in hyperactive behaviors. Girls in PATHS, relative to girls in the control, showed improvement in emotional knowledge and reduced anxiety. These results are considered in light of efforts to promote positive development and mental health.

Keywords
promoting alternative thinking strategies, cluster randomized controlled trial, social and emotional competence, mental health, preschool, children, universal prevention
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-197210 (URN)10.3389/fpsyg.2021.695288 (DOI)000679042900001 ()34326800 (PubMedID)
Available from: 2021-09-29 Created: 2021-09-29 Last updated: 2022-02-25Bibliographically approved
Baraldi, E., Allodi, M., Löwing, K., Smedler, A.-C., Westrup, B. & Ådén, U. (2021). Early intervention program of extreme preterm born infants, status report three years into the project. In: : . Paper presented at 8th Edition of Virtual Conference on Nursing Education & Practice, Barcelona, Spain, September 20-21, 2021..
Open this publication in new window or tab >>Early intervention program of extreme preterm born infants, status report three years into the project
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2021 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Children born extremely preterm (e.g. before 28 gestational weeks, EPT) runs a greater risk of cognitive, motor and neurobehavioral impairment later in life, compared to children born at term. Moreover, being a parent of an EPT born child increases the probability of developing depression and posttraumatic stress disorder post-partum, as well as the premature birth may affect the parent-child interaction negatively. In an attempt to decrease the psychological and motoric negative impact of both the child and parents, our multi-professional team has developed an early intervention during the first year at home focusing om parent-child interaction of the EPT born children: Stockholm Preterm Interaction-Based Intervention, SPIBI (Baraldi et al., 2020a). The target of the RCT is 130 children and after 32 months 112 children has been included in the study, evenly distributed in the intervention group and control group. At children’s corrected age of one-year, parents from 14 of the first included families were interviewed about their experiences from the intervention program, resulting in a qualitative article. Three main themes of parental experiences of the first year at home emerged: child-related concerns (concerning child medical state, self-regulation and recovery), parental inner state (concerning loneliness, ambivalence and premature parental identity), and changed family dynamics (concerning the couple, siblings and intergenerational support). The parents from the  intervention group reported that the intervention had given them security, a sense that the interventionist has been knowledgeable and in some cases that the program was important but not necessary to them (Baraldi et al., 2020b). With 85% of the targeted subjects included it is clear that an extensive early home-visit intervention program is feasible in the Swedish context, even though the pandemic has slowed down the recruitment pace and has forced adjustments to be made such as the use of telemedicine, exclusion of toys in the follow-up process and intensified hygienic procedures.

National Category
Nursing Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-194905 (URN)
Conference
8th Edition of Virtual Conference on Nursing Education & Practice, Barcelona, Spain, September 20-21, 2021.
Available from: 2021-07-19 Created: 2021-07-19 Last updated: 2024-04-29Bibliographically approved
Baraldi, E., Westling Allodi, M., Löwing, K., Smedler, A.-C. & Ådén, U. (2020). Home-visits during the first year of life: a strengths-based intervention for extremely premature infants and their parents, a randomized-control trial developed in Stockholm Region. In: : . Paper presented at Nordic Education Research Association NERA 2020, Turku, Finland, 4-6 March, 2020.
Open this publication in new window or tab >>Home-visits during the first year of life: a strengths-based intervention for extremely premature infants and their parents, a randomized-control trial developed in Stockholm Region
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2020 (English)Conference paper, Oral presentation only (Other academic)
Abstract [en]

In Sweden 400 children yearly are born extremely preterm (EPT; more than three months early). These children have an increased risk of later academic difficulties, neuropsychiatric disorder, cognitive and mental health issues. Since the first 1000 days of the brain development are so crucial for later development, the interdisciplinary Stockholm Preterm Interaction-Based Intervention (SPIBI) aims at strengthening the parent-child interaction, child development and parental mental health. 

The research is based on pedagogical, motor-developmental, medical and psychological science. The program is based on Vygotski’s theory of the zone of proximal development, as well theoretical frameworks of early intervention (Guralnick; Shonkoff). Additionally, Als’ synactive theory of understanding premature infant communication and needs, Bowlby’s attachment theory, and Emde’s emotional availability theory have been applied. 

SPIBI is an ongoing research project funded by Stockholm-County-Stockholm-University joint-collaboration grant 20160881. It is an RCT targeting 130 EPT infants and their parents in Stockholm with a 3-year inclusion period starting September 2018. The intervention consists of ten home-visits during the first year by trained interventionists, supporting the next developmental step of the child through a scaffolding process, strengthening parental sensitivity to infant cues, and promoting infant’s self-regulation. SPIBI has recruited and trained six multi-professional-NICU-experienced interventionists. Control group participants receive TAU plus an extended follow-up program.

The overall aim is to present the framework and theory of change of SPIBI, relating to research findings, welfare policies and recommendations for infant’s “chain of care”. So far, sixty eligible infants have been identified within four neonatal units; of which 48 approved participation. The primary outcome is emotional availability of the parent and child, where we hypothesize that the intervention will affect the parental sensitivity and structure of interaction with the child. Secondary outcomes concern child development, i.e. motor development, cognition and occurrence of neuropsychiatric symptoms, parental mental health, anxiety and self-efficacy, where we also hypothesize positive effects of the intervention. 

  • Since Nordic countries have neonatal intensive care of high quality, the amount of EPT survivors is high compared to other countries; therefore, the educational systems must follow achievements reached by health care system and develop new evidence-based interventions in early childhood education, which are appropriated for EPT born children and their parents, following recent European Standards of Care for Newborn Health (2018).
  • Insights from neuro-cognition, early intervention and educational research has shown the importance of interdisciplinary interventions, and this should be spread around the Nordic countries.
  • Nordic countries offer a unique social environment, with governmental funded parental-leave, enabling early-interventions delivered by parents.
  • The EPT children in Nordic countries are less affected by socioeconomic factors, as is often the case where maternity welfare and obstetrics is not publically financed. Hence, Nordic countries have a unique opportunity to perform research targeting EPT students and their parents specifically, with less confounding factors.
  • Some Nordic countries have adopted policies concerning home-visiting support and infants’ rights, as recommended by the World Association of Mental health’s policy statement from 2016, and Nordic knowledge exchange and collaboration on these policies is warranted. 
Keywords
extremely preterm, neuropsychiatric disorder, cognitive and mental health issues, SPIBI, interdisciplinary interventions
National Category
Pedagogy Psychology
Research subject
Educational Sciences in Arts and Professions
Identifiers
urn:nbn:se:su:diva-179819 (URN)
Conference
Nordic Education Research Association NERA 2020, Turku, Finland, 4-6 March, 2020
Available from: 2020-03-09 Created: 2020-03-09 Last updated: 2024-04-29Bibliographically approved
Baraldi, E., Westling Allodi, M., Smedler, A.-C., Westrup, B., Löwing, K. & Ådén, U. (2020). Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact. International Journal of Environmental Research and Public Health, 17(24), Article ID 9326.
Open this publication in new window or tab >>Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact
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2020 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 24, article id 9326Article in journal (Refereed) Published
Abstract [en]

With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent–child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent’s own emotional state.

Keywords
early intervention, follow-up, home-visit program, infancy, parent-child interaction, parenthood, preterm infant, strength-based approach, qualitative research
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-187556 (URN)10.3390/ijerph17249326 (DOI)000602829100001 ()
Projects
Stockholm Preterm Interaction-Based Intervention SPIBI
Available from: 2020-12-13 Created: 2020-12-13 Last updated: 2024-04-29Bibliographically approved
Baraldi, E., Westling Allodi, M., Löwing, K., Smedler, A.-C., Westrup, B. & Ådén, U. (2020). Stockholm preterm interaction-based intervention (SPIBI) - study protocol for an RCT of a 12-month parallel-group post-discharge program for extremely preterm infants and their parents. BMC Pediatrics, 20(1), Article ID 49.
Open this publication in new window or tab >>Stockholm preterm interaction-based intervention (SPIBI) - study protocol for an RCT of a 12-month parallel-group post-discharge program for extremely preterm infants and their parents
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2020 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 20, no 1, article id 49Article in journal (Refereed) Published
Abstract [en]

Background: Improved neonatal care has resulted in increased survival rates among infants born after only 22 gestational weeks, but extremely preterm children still have an increased risk of neurodevelopmental delays, learning disabilities and reduced cognitive capacity, particularly executive function deficits. Parent-child interaction and parental mental health are associated with infant development, regardless of preterm birth. There is a need for further early interventions directed towards extremely preterm (EPT) children as well as their parents. The purpose of this paper is to describe the Stockholm Preterm Interaction-Based Intervention (SPIBI), the arrangements of the SPIBI trial and the chosen outcome measurements.

Methods: The SPIBI is a randomized clinical trial that includes EPT infants and their parents upon discharge from four neonatal units in Stockholm, Sweden. Inclusion criteria are EPT infants soon to be discharged from a neonatal intensive care unit (NICU), with parents speaking Swedish or English. Both groups receive three initial visits at the neonatal unit before discharge during the recruitment process, with a strengths-based and development-supportive approach. The intervention group receives ten home visits and two telephone calls during the first year from a trained interventionist from a multi-professional team. The SPIBI intervention is a strengths-based early intervention programme focusing on parental sensitivity to infant cues, enhancing positive parent-child interaction, improving self-regulating skills and supporting the infant’s next small developmental step through a scaffolding process and parent-infant co-regulation. The control group receives standard follow-up and care plus extended assessment. The outcomes of interest are parent-child interaction, child development, parental mental health and preschool teacher evaluation of child participation, with assessments at 3, 12, 24 and 36 months corrected age (CA). The primary outcome is emotional availability at 12 months CA.

Discussion: If the SPIBI shows positive results, it could be considered for clinical implementation for child-support, ethical and health-economic purposes. Regardless of the outcome, the trial will provide valuable information about extremely preterm children and their parents during infancy and toddlerhood after regional hospital care in Sweden.

Trial registration: The study was registered in ClinicalTrials.gov in October 2018 (NCT03714633).

Keywords
child cognitive development, child motor development, early intervention, emotional availability, extreme prematurity, parent-child interaction, pediatrics
National Category
Pediatrics Psychology
Research subject
Pediatrics
Identifiers
urn:nbn:se:su:diva-178772 (URN)10.1186/s12887-020-1934-4 (DOI)000512710000001 ()
Available from: 2020-02-05 Created: 2020-02-05 Last updated: 2024-04-29Bibliographically approved
Stålnacke, J., Lundequist, A., Böhm, B., Forssberg, H. & Smedler, A.-C. (2019). A longitudinal model of executive function development from birth through adolescence in children born very or extremely preterm. Child Neuropsychology, 25(3), 318-335
Open this publication in new window or tab >>A longitudinal model of executive function development from birth through adolescence in children born very or extremely preterm
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2019 (English)In: Child Neuropsychology, ISSN 0929-7049, E-ISSN 1744-4136, Vol. 25, no 3, p. 318-335Article in journal (Refereed) Published
Abstract [en]

Executive function deficits are often reported as a specific weakness in preterm children. Yet, executive function development is still not fully understood. In a prospective longitudinal study, 115 preterm born children, <= 31 weeks of gestation, were recruited at birth and subject to neuropsychological assessments at ages 5.5 and 18 years. By applying Miyake and colleagues' integrative framework of executive function to our data, two core components of executive function, working memory and cognitive flexibility, were identified through confirmatory factor analysis. Developmental stability was investigated in a serial multiple mediator structural equation model. Biological, medical, and social factors as well as mental development at 10 months were entered as predictors. Both components of executive function were highly stable from 5.5 to 18 years. Gestational age, intrauterine growth, lack of perinatal medical complications, and female sex were positively related to mental development at 10 months, which together with parental education influenced both core executive functions at 5.5 years. Working memory at 5.5 years mediated outcome in working memory at 18 years. In addition to the mediation of cognitive flexibility at 5.5 years, perinatal medical complications and restricted intrauterine growth had a continued direct negative impact on cognitive flexibility at 18 years. The application of a theoretical framework added to our understanding of executive function development in preterm born children. The study supports early identification of executive deficits among children born preterm, as deficits are unlikely to diminish with maturation.

Keywords
cognitive flexibility, parental education, perinatal medical complications, serial multiple mediator model, working memory
National Category
Psychology Neurosciences
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-166649 (URN)10.1080/09297049.2018.1477928 (DOI)000456954000002 ()29847202 (PubMedID)
Available from: 2019-03-11 Created: 2019-03-11 Last updated: 2022-03-23Bibliographically approved
Baraldi, E., Westling Allodi, M., Löwing, K., Smedler, A.-C., Westrup, B. & Ådén, U. (2019). Clinical Protocol & Research Process of Stockholm Preterm Interaction-Based Intervention, SPIBI. Paper presented at 3rd congress of Joint European Neonatal Societies (jENS 2019), Maastricht, the Netherlands, 17–21 September, 2019. Pediatric Research, 86(Suppl.), 54-55
Open this publication in new window or tab >>Clinical Protocol & Research Process of Stockholm Preterm Interaction-Based Intervention, SPIBI
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2019 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 86, no Suppl., p. 54-55Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background

Extremely preterm (EPT) born children are at increased risk of cognitive and neurodevelopmental impairment, neuropsychiatric disorders and academic difficulties. Parents of EPT born children are extra vulnerable for anxiety, posttraumatic stress disorder and depression and the parent-child interaction is negatively affected by prematurity. There is some evidence that early interventions have beneficial effects on neurocognitive and motor outcomes (Spittle A et al 2015). Based on a previous intervention (Verkerk G et al 2012) and adjusted to the Swedish context with 480 days paid parental leave, we created a post–discharge intervention, SPIBI, for families of EPT born children.

Method

The aim of (SPIBI) is to improve the quality of the parent-child interaction, child development and parental mental health in families with EPT born children. . SPIBI is a randomized controlled beginning at discharge and lasting until the child is 12 months corrected age. The trial design is a two arm randomized trial with four recruiting sites in Stockholm. Intervention group (target, n=65) receives 10 visits and two telephone calls from a trained interventionist and the control group (target n=65) receives treatment as usual plus an extended follow-up program. The SPIBI-team has recruited and trained 6 multi-professional and NICU-experienced interventionists. The training takes one year (0.2 of full time) and the content was both theoretical and practical, including pilot-cases. 

Result

SPIBI is an ongoing research project, beginning the 1st of September 2018 and planning to end recruitment the 31st of August 2020 and finishing the home-visits in August 2021. By the end of April 2019, 33 eligible infants had been identified within the four neonatal units in Stockholm; of which 26 children approved and 7 children declined participation. At this stage, three children have dropped out of the study, because of severe social challenges and child death. Identified challenges have been social and medical vulnerability of the EPT-families, finding the optimal multi-professional balance of motoric, psychological, pedagogical and medical kernels of the intervention, ethical considerations when to ask families for participation, lack of long-term discharge-planning of the neonatal units and large geographical spread of NICUs as well as families.

Conclusion

In conclusion, the protocol seem to be feasible and appreciated by parents in the target group. With regard to the small recruitment base, trials of this kind needs a long inclusion time. Since EPT-children and their parents displays a wide scope of difficulties and challenges, multi-professional cooperation is preferable, placing high demands of sensitivity, professional respect and time for long collaborative processes.

Keywords
child cognitive development, child motor development, early intervention, extreme prematurity, parent-child interaction, parental mental health, self-regulation
National Category
Pediatrics Psychology
Research subject
Special Education; Psychology
Identifiers
urn:nbn:se:su:diva-173518 (URN)10.1038/s41390-019-0521-6 (DOI)
Conference
3rd congress of Joint European Neonatal Societies (jENS 2019), Maastricht, the Netherlands, 17–21 September, 2019
Available from: 2019-09-25 Created: 2019-09-25 Last updated: 2024-04-29Bibliographically approved
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