Infants In Intervention Group Research Articles

Effects of responsive breastfeeding intervention on breastfeeding and infant growth in China: A randomised controlled trial.

Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self-determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother-infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self-efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post-partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post-partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self-perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post-partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post-partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: -2.09; 95% CI: -2.88 to -1.31; p < 0.001), 6 weeks post-partum (MD: -4.35; 95% CI: -5.20 to -3.49; p < 0.001) and 3 months (MD: -4.89; 95% CI: -5.70 to -4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post-partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post-partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post-partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post-partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post-partum, the intervention group's infants showed slower weight (t = -0.90, p = 0.371) and length (t = -0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post-partum, there was a significant difference in both weight (t = -3.46, p = 0.001) and length (t = -2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self-confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow-up in future research.

Prolonged Oral Motor Stimulation Treatment was Effective for Breastfeeding Achievement in Full Term Infants With Feeding Problems

Objectives: Feeding problems can occur in early-term infants born at 37 weeks. Early-term and full-term infants may benefit from oral motor therapy to attain successful breastfeeding. The present study aims to determine the impact of the 5-minute premature infant oral motor intervention (PIOMI) and the 15-minute oral stimulation program (15-minute oral stimulation program) on 37 to 41 weeks infants in attaining successful breastfeeding. Methods: This clinical trial was conducted on early-term and full-term infants in the neonatal intensive care units (NICUs) of two hospitals in Mashhad City, Iran. They were randomly divided into two intervention groups (5-minute PIOMI or 15-minute oral stimulation program) and one control group (17 infants in each group). These three groups were then compared to each other after the intervention by pediatricians and speech and language specialists regarding their breastfeeding. All statistical analysis was performed using R software, version 4.0.2, and the significance level was set at 0.05. Results: Infants in both intervention groups attained different levels of breastfeeding compared to pre-intervention. This outcome could be due to our interventions or natural growth and development (P&lt;0.05). However, the longer the infants’ oral motor therapy time was, the more likely they were to breastfeed successfully. The 15-minute oral stimulation program group had a significantly higher number of male infants attaining breastfeeding after treatment than the control and PIOMI groups (P=0.03). Discussion: The PIOMI has been confirmed as an effective early intervention for small preterm infants as young as 29 weeks, and the short 5-minute therapy time is accepted in the preterm infant population. The program affects the brain’s plasticity and improves neurosensory and motor skill development for feeding. The current study indicates that PIOMI remains effective versus the control group in the full-term babies. However, the longer 15-minute oral stimulation program, is more effective in full-term infants. This finding shows that full-term infants can endure and benefit from longer than 5 minutes per day of oral motor therapy.

Preliminary findings of emotion regulation in 12-month-old infants of mothers enrolled in a randomized controlled trial assessing a nutrition+exercise intervention.

Improved offspring emotion regulation (ER) has been associated with maternal intake of single nutrients or exercise during pregnancy but has not been examined in randomized trials. We investigated the impact of a maternal nutrition+exercise intervention during pregnancy on offspring ER at 12months of age. Mothers in the Be Healthy In Pregnancy randomized controlled trial were randomly assigned to an individualized nutrition+exercise intervention plus usual care (UC) or UC alone (control group). A multimethod assessment of infant ER using parasympathetic nervous system function (high frequency heart rate variability [HF-HRV] and root mean square of successive differences [RMSSD]) as well as maternal reports of infant temperament (Infant Behavior Questionnaire- Revised short form) was completed with a subsample of infants of enrolled mothers (intervention=9, control=8). The trial was registered at www.clinicaltrials.gov (NCT01689961). We observed greater HF-HRV (M=4.63, SD=0.50, p=.04, ƞ2 p =.25) and RMSSD (M=24.25, SD=6.15, p=.04, ƞ2 p =.25) in infants of mothers in the intervention versus control group. Intervention group infants also had higher maternally rated surgency/extraversion (M=5.54, SD=0.38, p=.00, ƞ2 p =.65) and regulation/orienting (M=5.46, SD=0.52, p=.02, ƞ2 p =.81), and lower negative affectivity (M=2.70, SD=0.91, p=.03, ƞ2 p =.52). These preliminary results suggest that pregnancy nutrition+exercise interventions could improve infant ER but these findings require replication in larger, more diverse samples.

Effectiveness of early spectacle intervention on visual outcomes in babies at risk of cerebral visual impairment: a parallel group, open-label, randomised clinical feasibility trial protocol

IntroductionHypoaccommodation is common in children born prematurely and those with hypoxic ischaemic encephalopathy (HIE), with the potential to affect wider learning. These children are also at risk of longer-term cerebral...

Infant massage and brain maturation measured using EEG: A randomised controlled trial

BackgroundVery preterm (VPT) infants develop adverse neurological sequelae from early exposure of the immature brain to the extrauterine environment. AimsTo determine the effects of infant massage on brain maturation in low-risk VPT infants. Study designA randomised controlled trial of VPT infants, who received standard care or daily massage therapy, administered by the mother, from 34 weeks' to 40 weeks' corrected age (CA). SubjectsVPT infants (born at 28 weeks to 32 + 6 weeks' gestational age, G.A.) and a healthy at term cohort for comparison. Outcome measuresAt term equivalent age (39 weeks' to 42 weeks' CA), EEG was recorded to calculate global relative power (GRP), using power spectral analysis. ResultsSixty infants were recruited, and EEGs of 25 massage and 20 standard care infants were analysable. There was no difference between groups in primary outcome (beta GRP). There was a significantly higher central alpha relative power measured in the intervention group infants, compared to standard care (SC) group (mean difference = 1.42, 95 % confidence interval (CI): 0.12 to 2.73; p = 0.03). A massage dose effect was shown by a positive correlation between, massage dose and beta, alpha and theta GRP (r = 0.42, 95%CI = 0.12 to 0.64, r = 0.45; 95%CI = 0.16 to 0.66, r = 0.39; 95%CI = 0.10 to 0.62 respectively) and a negative correlation between massage dose and delta GRP (r = −0.41, 95%CI = −0.64 to −0.12), suggesting that a higher dose of massage is associated with more favourable brain maturation. ConclusionsCentral alpha regional relative power was greater in massaged infants compared to SC group infants, suggesting relatively greater brain maturation in this area. A measurable massage dose effect in favour of greater brain maturation, shows promise for verification in a larger clinical trial.

The position during urine sample collection from young precontinent children through a bag does not limit contamination rates: Results from a randomized controlled trial: Does infant position influence quality of urine collection?

AimDespite its limitation, bag collection is still widely used for a preliminary urine screening test in non-toilet-trained children suspected of febrile urinary tract infection. A previous study conducted by our group raised the hypothesis that the absence of direct contact between urine and the perinea during urine collection could limit urine contamination by perineal flora. The aim of this study was to evaluate the impact of the patient's position during urine collection (upright standing position versus free position) on the rate of contaminated urine samples in non-toilet-trained children with suspected febrile urinary tract infection. MethodsThis prospective, randomized, controlled study took place in seven pediatric emergency departments. Two groups were compared: the intervention group (infants held in an upright standing position during urination) and the control group (free position during urination). ResultsAmong the 800 pediatric patients randomized to the study, 124 had a urine culture, 60 in the intervention group and 64 in the control group. Among the 124 urine cultures, 12 (9.7%) were contaminated: eight (13.3%) in the intervention group and four (6.3%) in the control group (p = 0.1824). ConclusionThe results show that the patient's position does not have a significant impact on the quality of urine samples collected by bag.

Impact of State Prioritization of Safe Infant Sleep Programs on Supine Sleep Positioning for Non-Hispanic White and Non-Hispanic Black Infants.

Investigate whether safe infant sleep prioritization by states through the Title V Maternal and Child Block Grant in 2010 differentially impacted maternal report of supine sleep positioning (SSP) for Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) U.S.-born infants. We analyzed retrospective cross-sectional data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2005 to 2015 from 4 states: WV and OK (Intervention) and AR and UT (Control). PRAMS is a population-based surveillance system of maternal perinatal experiences which is linked to infant birth certificates. Piece-wise survey linear regression models were used to estimate the difference in the change in slopes of SSP percents in the pre- (2005-2009) and post- (2011-2015) periods, controlling for maternal and infant characteristics. Models were also stratified by race/ethnicity. From 2005 to 2015, for NHW infants, SSP improved from 61.5% and 70.2% to 82.8% and 82.3% for intervention and control states, respectively. For NHB infants, SSP improved from 30.6% and 26.5% to 64.5% and 53.1% for intervention and control states, respectively. After adjustment for maternal characteristics, there was no difference in the rate of SSP change from the pre- to post- intervention periods for either NHW or NHB infants in intervention or control groups. Compared with control states that did not prioritize safe infant sleep in their 2010 Title V Block Grant needs assessment, intervention states experienced no difference in SSP improvement rates for NHW and NHB infants. While SSP increased for all infants during the study period, there was no causal relationship between states' prioritization of safe infant sleep and SSP improvement. More targeted approaches may be needed to reduce the racial/ethnic disparity in SSP and reduce the risk for sleep-associated infant death. · Supine sleep positioning improved for Black and White infants in the U.S.. · State prioritization of safe infant sleep did not directly impact SSP for NHB or NHW infants.. · More targeted approaches may be needed to reduce racial/ethnic disparities in safe sleep practices.

Effects of Implementation of Infant-Driven Oral Feeding Guideline on Preterm Infants' Abilities to Achieve Oral Feeding Milestones, in a Tertiary Neonatal Intensive Care Unit.

This study examines the hypothesis that infant-driven oral feeding leads to earlier achievement of oral feeding and reduces the length of hospital stay compared with provider-driven oral feeding in premature infants METHODS: We used a retrospective chart review to compare 2 groups of premature infants born at ≤35 weeks of gestation. The control group (CG) received the Provider-Driven Oral Feeding model and the intervention group (IG) received the Infant-Driven Oral Feeding model. Postmenstrual age (PMA) upon achieving full oral feeding, PMA at first oral feeding, discharge weight, and length of hospital stay were compared between the groups. There are 208 infants in CG and 170 infants in IG. Infants in IG were born, on average, at a lower gestational age and birth weight than infants in CG. The median PMA at full oral feeding of 35 2/7 weeks (interquartile range [IQR], 34 2/7-36 2/7) for IG is significantly lower than the median of 35 5/7 weeks (IQR, 35-36 5/7) for CG, P-value < 0.001. Median PMA at first oral feeding is 34 1/7 weeks for both groups. Median PMA at discharge was 36 6/7 weeks for both groups. Median discharge weights of 2509 g (IQR, 2175-2964) for IG and 2459 g (IQR, 2204-2762) for CG are not statistically different. Implementation of the Infant-Driven Feeding guideline led to earlier achievement of full oral feeding by 3 days on average while maintaining the same discharge weight but did not lead to earlier hospital discharge.

Exploring the potential utility and impact of a universal, multi-component early parenting intervention through a community-based, controlled trial

BackgroundThis paper describes the first phase of a community-based, controlled trial conducted to investigate the potential utility of a new, complex group-based early parenting intervention. In total, 106 parent-infant dyads were recruited to an interagency Parent and Infant (PIN) intervention which combines a range of supports, including the Incredible Years Parent and Baby Programme, baby massage, weaning workshops and paediatric first aid training. A ‘services-as-usual’ comparison group was also recruited (n = 84). MethodsThe primary outcome was parenting self-efficacy (Parenting Sense of Competence Scale). Parent well-being, child development and the home environment were also measured. Assessments were conducted at baseline (when infants were 6–20 weeks old) and at follow-up (when infants were aged approximately 8 months). Parent satisfaction with the intervention was examined, as well as uptake of community-based services and health service utilisation. ResultsAn intention-to-treat analysis of covariance (ANCOVA) examined between-group post-intervention differences, whilst secondary analyses on a ‘per protocol’ sample of participants (who attended at least 50% of the intervention sessions) were also conducted. Satisfaction with the PIN intervention was very high. The intention-to-treat ANCOVA showed no post-intervention between-group differences on measures of parent competency or well-being. At baseline, children in the comparison group were older than those in the intervention group and, at follow-up, fared better than their intervention group counterparts on measures of child development. The per protocol analysis revealed a significant effect for the intervention group on the efficacy subscale of the primary outcome measure (effect size = 0.44, p < 0.05). Intervention group infants attended GP and nursing services on significantly fewer occasions than their comparison group counterparts. ConclusionThe findings provide tentative early support for the utility of the PIN intervention in terms of improving parenting efficacy and reducing reliance on primary health care services. Further follow-ups when infants are 16 and 24 months old are underway.

Less invasive surfactant administration reduces incidence of severe intraventricular haemorrage in preterms with respiratory distress syndrome: a cohort study.

Less invasive surfactant administration (LISA) has proved to safely improve morbidity in extreme preterms with respiratory distress syndrome (RDS). Its effect regarding intraventricular hemorrhage (IVH) remains controversial between most recent systematic reviews. We aimed to evaluate its effect over incidence of severe IVH in this population. We compared the incidence of IVH in a prospective cohort of consecutively born preterm infants <34 weeks' gestation receiving LISA (n = 108) with a historical cohort receiving surfactant delivery via tracheal tube and managed with mechanical ventilation (n = 100). No significant differences regarding perinatal characteristics were observed between both groups. There was a significant reduction in the incidence of severe IVH in LISA group as compared with the historical group [OR = 0.054 (95% CI 0.01-0.2) p = 0.000. NNT 5]. In addition, a significant trend towards decreased mortality was also observed in the study group [OR = 0.2 (95% CI 0.04-0.9) p = 0.027, NNT 9]. Intervention group infants also showed lower oxygenation requirements during the first 72 h post surfactant administration and a reduced incidence of pneumothorax. They were less frequently intubated [31 infants (28.4%) vs. 100 [100%]; P < 0.001] and required fewer days of mechanical ventilation. However, no significant difference in bronchopulmonary dysplasia incidence was observed between both groups. LISA approach effectively reduces severe IVH in very low and low birth weight (BW) preterms with RDS. In addition we observe a significant trend towards reduction in both need and duration of MV support, air leak, and overall mortality in the intervention group.

EFFECTIVENESS OF MUROTTAL THERAPY ON BABIES’ WEIGHT CHANGES

Many newborn babies have a low weight, it has a bad impact in the process of growth and development.Murottal is a recording of the sound of the Qur'an which is sung by a qori . Murotal therapy performed for several minutes or hours in a voice that sounds good can give a sense of comfort for the body to move up to be able to raise the baby's weight. The Purpose Of This Research Is To Know The Murottal Effects Of Changes In Baby Weight. This research is quasi experimental pre-test post test kontrol group design. Samples in this study A total of 44 newborn babies, divided into two groups consisting of 22 respondents, namely the Intervention Group and the Control Group. The Intervention Group received treatment hearing murottal therapy and the control group did not receive treatment. Using the Mann Whitney statistical test. The results of the study with the Mann Whitney Statistical Test p: 0.630> 0.05. This means that there is no average difference between the weight of infants in the intervention group and the control group. However, it only gave a change, by showing that the weight of the intervention group infants after being given a treatment was lower in body weight compared to the control group which was 2,577 grams, whereas in the control group without being treated there was more weight loss than the intervention group which was 2,750 grams. Murottal therapy has not changed statistically but there has been a change in the mean and standard deviation, so it is recommended that mothers apply Murottal therapy during the breastfeeding process using appropriate Standard operating procedures.

Individualized target fortification of breast milk with protein, carbohydrates, and fat for preterm infants: A double-blind randomized controlled trial.

In preterm infants, natural variation of breast milk composition makes it difficult to achieve recommended macronutrient intakes with standard fortification. Evidence suggests that nutritional deficiency induces poor postnatal growth. This study investigates impacts of target fortification on preterm growth and metabolism by adjusting breast milk macronutrients. This study was conducted as a single-centre, double-blind, randomized controlled trial for infants <30 gestational weeks. The control group received standard fortification and the intervention group received standard plus target fortification adding modular protein, lipids, and carbohydrates. Breast milk content was measured 3x/week using a validated near-infrared bedside spectrometer (NIRS). Modulars were added to achieve recommended values. To assess total nutrient intake, all 2810 native breast milk samples were analyzed - protein and fat using bedside-NIRS, lactose using tandem mass spectrometry (UPLC-MS/MS). Body composition was measured using air displacement plethysmography. Primary outcome was weight gain during the first 21 days of intervention. Baseline characteristics, morbidities, and total fluid intake were not different between groups (intervention n=52, control n=51). The intervention group infants had higher macronutrient intakes, weight gain (21.2±2.5 vs 19.3±2.4g/kg/d, mean difference: 1.9g/kg/d, 95% CI: 0.9 - 2.9), and body weight. Infants in the intervention group from mothers with below-average breast milk protein content showed greatest impact on weight at 36 weeks (2580±280g vs 2210±300g), length, head circumference, fat, and fat-free mass. Also, feeding intolerance was less frequent, blood urea was higher, and triglycerides were lower. This study provides evidence that target fortification of breast milk with low macronutrient content enhances the quality of nutrition and growth and is feasible in clinical routine.

Effects of kangaroo mother care on anxiety and parenting stress in premature mothers

Objective To investigate the application effect of kangaroo mother care on anxiety and parenting stress in premature mothers during hospitalization. Methods From January to December 2018, 230 premature mothers were admitted to the neonatal intensive care unit of Ningxia Medical University General Hospital.They were randomly divided into the intervention group(n=114) and the control group(n=116). The premature infants in control group only implemented routine developmental support care.The premature infants in the intervention group was on the basis of routine developmental support care, 2 hours per day of kangaroo mother care was performed from the 2nd day incharge to discharge.Parental Stress Scale: Neonatal Intensive Care Unit and Parenting Stress Index-Short Form was performed using the 2nd day and the 14th day of hospitalization, and the two groups of premature mothers were evaluated for anxiety and parenting stress. Results There were no significant differences in the scores of PSS: NICU((3.65±0.91) vs (3.63±0.91)) and PSI-SF((90.32±8.95) vs (90.12±7.17))(both P>0.05) between the two groups on the 2nd day of hospitalization (before intervention). On the 14th day of hospitalization (after intervention), the total scores ((2.57±0.80) vs (3.47±0.93))and each dimension scores of PSS: NICU in the intervention group were lower than those in the control group (first part (2.41±0.78) vs (3.81±0.73), second part (2.61±0.71) vs (3.14±0.83), third part (2.75±0.86) vs (3.57±1.06), fourth part(2.49±0.80) vs (3.35±0.94))(P<0.01). In addition, the total score of PSI-SF((79.09±8.02) vs (89.46±8.74)), parenting Distress((32.32±9.48) vs (37.15±9.67)), Parent-Child Dysfunctional Interaction((24.26±5.07) vs (27.34±5.26)), and Difficult Child scores((22.51±4.88) vs (24.97±5.05)) in the intervention group were lower than those in the control group(P<0.01). Conclusion Kangaroo mother care can reduce the anxiety of premature mothers during hospitalization and help relieve the parenting stress of premature mothers. Key words: Kangaroo mother care; Premature infant; Anxiety; Parenting stress

Effect of comprehensive feeding intervention on feeding intolerance of premature infants

Objective To investigate the effect of comprehensive feeding intervention on feeding quality and weight gain of premature infants. Methods Eighty-one premature infants admitted to the neonatal intensive care unit (NICU) of our hospital from September 2016 to December 2018 were selected and randomly divided into the intervention group (n=41) and the control group (n=40). Infants in the control group received routine nursing and infants in the intervention group were given comprehensive feeding intervention on the basis of routine nursing includingimproved Y type gastric tube, gravity tube feeding in prone position, oral movement intervention, colostrum oral immunotherapy and kangaroo nursing. The changes of feeding process were compared between the two groups and the occurrence of feeding intolerance in the two groups was observed. Results The duration of tube feeding and hospital stay were lower in the intervention group than in the control group (P 0.05), but the average daily weight growth rate [g/(kg·d) ] after 1 week and the milk volume [ml/(kg·d)] at 1 week were higher in the intervention group than in the control group(P<0.05). The incidence of gastric retention, abdominal distension and vomiting in the intervention group was lower than that in the control group, but only the difference in the incidence of gastric retention (24.4% vs 47.5%) was statistically significant (P<0.05). The incidence of feeding intolerance was significantly lower in the intervention group than in the control group (24.39% vs 47.50%, P<0.05). Conclusion Comprehensive nursing intervention can shorten the tube feeding time of premature infants, promote the weight growth of premature infants, improve the feeding quality, reduce the incidence of feeding intolerance, and reduce the hospital stay of premature infants, so as to reduce the hospitalization cost, improve the quality of life of premature infants, and increase the satisfaction of parents. Key words: Comprehensive nursing intervention; Premature infant; Feeding intolerance

Effects of early essential newborn care on hypothermia and short-term outcomes in vaginally born preterm infants

Objective To investigate the effects of early essential newborn care (EENC) on body temperature and short-term clinical outcomes of vaginally born preterm infants at 1 h after birth. Methods This was a prospective case-control study. A total of 97 premature infants, who were born vaginally between 34-37 weeks in the Obstetrics Department of General Hospital of Ningxia Medical University from January 1 to December 31, 2017 and admitted to the neonatal intensive care unit were enrolled as intervention group. Another 103 premature infants, who were born vaginally in the Obstetrics Department of Yinchuan Maternal and Child Health Hospital at the same period were enrolled as control group. EENC-based treatment and management were implemented to infants in the intervention group, such as thorough drying immediately, 30 min skin-to-skin contact immediately and delayed cord clamping after birth, etc., while those in the control group were managed based on routine protocol. Chi-square test was used to compare the incidence of hypothermia, hypoglycemia and hypoxemia between the two groups at 1 h after birth. The general condition and the time of colostrum secretion were compared by two independent sample t-test. Multivariate logistic regression was used to analyze the risk factors of hypothermia. Results At last, 96 participants in the intervention group and 102 in the control group were analyzed. Compared with the control group, the intervention group showed lower incidence of hypothermia [17.7% (17/96) vs 37.3% (38/102), χ2=9.418, P=0.002], hypoglycemia [9.4% (9/96) vs 19.6% (20/102), χ2=4.142, P=0.042] and hypoxemia [14.6% (14/96) vs 28.4% (29/102), χ2=5.578, P=0.018] at 1 h after birth and earlier colostrum secretion [(18.3±2.4) vs (31.4±3.5) min, t=32.463, P<0.001]. Multivariate logistic regression analysis showed that birth weight <2 500 g (OR=2.483, 95%CI: 1.731-3.234, P=0.025), gestational age<36 weeks (OR=1.899, 95%CI: 1.325-2.472, P=0.012), room temperature between 22-24 ℃ in the delivery ward (OR=2.465, 95%CI: 1.279-4.754, P=0.007), no-skin contact (OR=2.958, 95%CI: 1.435-4.481, P=0.023) and rapid and simple drying (OR=2.467, 95%CI: 1.285-4.736, P=0.006) were the risk factors for hypothermia in premature infants. Conclusions EENC can reduce the incidence of hypothermia, hypoglycemia and hypoxemia in premature infants at 1 h after birth and may be helpful for early colostrum secretion. Key words: Hypothermia; Infant, premature; Neonatal nursing

The effect of a maternal training programme on early childhood development in Egypt.

The initial years of life, particularly the first two years, are considered the most important for brain development and timely interventions profoundly affect the health of the child and families. This study aimed to determine the effect of maternal health education on motor, social and cognitive development in infants less than two years old, and to identify the factors that could affect normal development. Two hundred and ten mothers and their infants (109 interventions, 101 controls) were recruited from maternal and child health centres in Assiut Governorate, Egypt, in 2017. The maternal training programme has been taught to mothers of infants in intervention groups twice per month and up to five months' duration; however, routine services are provided to control groups only. Bivariate and multivariable analyses were performed to identify the most important predictors of normal development. There were significant improvements in early childhood developmental domains for the intervention groups after five months comparable to the base line assessment. Percent of normal development among intervention groups in communication subscale increased from 46.8% to 76% to 97.9% compared to 50.5% to 46.8% to 57.4% in the control groups (baseline, after two month and after five months assessment respectively). The intervention was a significant predictor in normal development. There was an improvement in early childhood developmental domains for the intervention groups after applying maternal training programme. Designing educational interventions for routine health care services that reach all children will provide mothers with the opportunity for improvement in early childhood developmental.

NP20 Starting Early: Expansion of a Primary Care-Based Early Child Obesity Prevention Program

Objective Determine “Starting Early Program” (StEP) impacts on infant feeding practices and weight and develop expanded prenatal and pre-school StEP interventions. Description We conducted a randomized controlled trial testing the efficacy of StEP, a comprehensive early child obesity prevention program using prenatal and pediatric primary care to target low-income, Hispanic families. English/Spanish speaking pregnant Hispanic women were enrolled in the third trimester to standard primary care control group vs. StEP intervention group (prenatal/postpartum nutrition counseling, and nutrition and parenting support groups coordinated with well-child visits until child age three years). Expanded prenatal and preschool StEP curricula for women beginning in the first trimester and children aged 3-5 years were developed. Evaluation Intervention outcomes assessed at child age 3, 10, 19 months and 2, 3, 4 and 5 years. Maternal infant feeding and activity practices assessed using 24-hour diet recalls and validated surveys. Measured child weight for age z-scores (WFAz) determined from CDC growth charts. Intent to treat analyses and within group analyses for intervention dose impacts were conducted. We randomized 533 low-income women into the original trial. 88%, 78%, 74%, 76% and 75% of mother-infant pairs completed assessments at 3, 10, and 19 months, and 2 and 3 years. Intervention pairs had healthier feeding and activity practices (more exclusive breastfeeding, tummy time; less cereal in the bottle, excess milk intake and non-responsive feeding styles). By age two, intervention group infants had lower WFAz than controls (0.62(1.11) vs. 0.85(1.17); P = .046). Median number of sessions attended was 7.0(SD3.5)/12. High attendance reduced the odds of being overweight (AOR 0.42, P = .02). To date, a new expanded prenatal cohort is being enrolled in the 1st trimester (goal n = 200); 309 pairs from the original cohort enrolled for continuation, 4- and 5-year assessments on-going. Conclusion and Implications StEP intervention infants had healthier feeding practices and lower weight at two years, with dose dependent reduction in overweight. Findings demonstrate a scalable system to potentially augment obesity prevention in primary care for at-risk families.

Exploring infant signing to enhance responsive parenting: Findings from the INSIGHT study.

Responsive parenting is a promising framework for obesity prevention, yet attempts to date have largely relied on parents accurately interpreting their child's cues. Infant signing or "baby sign language" could enhance these interventions by improving bidirectional parent-child communication during the preverbal and emerging language years. In a clinical trial testing, a responsive parenting intervention designed for obesity prevention, we pilot tested a brief intervention at age 40weeks with a subset of participating dyads that taught the signing gesture of "all done" to improve parental recognition of satiety. In addition, we surveyed all participating mothers at child age 18months on the use of infant signing gestures in the prior year. Two hundred twenty-eight mothers completed the survey including 72 responsive parenting group mothers that received the signing instructions. A majority of mothers, 63.6%, reported teaching their infant signs in the prior year, and 61.4% of infants were using signs to communicate at 18months (median signs=2). The signs for "more" and "all done" were used by over half of study participants and were the most common signs used. Other signs related to eating or drinking were commonly used. Signing intervention group infants were more likely to use the sign for "all done" than controls (63.9% vs. 45.5%; P=0.01), but there was no difference between groups with regard to the use of the sign for "more" (56.9% vs. 51.3%; P=0.43). Signing is commonly used by parents of young children and holds potential to improve parental responsiveness and obesity prevention efforts.

Improving exclusive breastfeeding in low and middle‐income countries: A systematic review

Exclusive breastfeeding (EBF) rates until 6months in most low and middle income countries (LMICs) are well below the 90% World Health Organization benchmark. This systematic review sought to provide evidence on effectiveness of various interventions on EBF until 6months in LMICs, compared with standard care. Experimental and observational studies with concurrent comparator promoting EBF, conducted in LMICs with high country rates of breastfeeding initiation, were included. Studies were identified from a systematic review and PUBMED, Cochrane, and CABI databases. Study selection, data abstraction, and quality assessment were carried out independently and in duplicate. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated for individual studies and pooled. High heterogeneity was explored through prespecified subgroup analyses for the primary outcome (EBF until 6months) by context and by intervention for the randomized controlled trials. Prediction intervals were calculated for each effect estimate. Sixty-seven studies with 79 comparisons from 30 LMICs were included. At 6months, intervention group infants were more likely to be exclusively breastfed than controls (RR=2.19, 95% CI [1.73, 2.77]; I2 78.4%; 25 randomized controlled trials). Larger effects were obtained from interventions delivered by a combination of professional and laypersons (RR 3.90, 95% CI [1.25, 12.21]; I2 46.7%), in interventions spanning antenatal and post-natal periods (RR 2.40, 95% CI [1.70, 3.38]; I2 83.6%), and when intensity was between four to eight contacts/sessions (RR 3.20, 95% CI [2.30, 4.45]; I2 53.8%). Almost every intervention conducted in LMICs increased EBF rates; choice of intervention should therefore be driven by feasibility of delivery in the local context to reduce infant mortality.

NP31 - Starting Early/Empezando Temprano: Randomized Control Trial to Test the Effectiveness of a Child Obesity Prevention Program

Objective: To improve maternal infant feeding and activity practices and reduce child obesity with the Starting Early Program (StEP): a primary care-based obesity prevention intervention beginning in pregnancy for low-income Hispanic mother-infant dyads. Description: Conduct a randomized control trial of the StEP intervention. Women enrolled in the third trimester of pregnancy at an urban public hospital clinic, randomized to StEP intervention vs. standard primary care. Intervention included: individual nutrition counseling in prenatal/peri-partum periods, nutrition and parenting support groups at every well child visit with 2 individual and 13 group intervention sessions scheduled prior to child age 3 years. Feeding styles, diet and lifestyle patterns, psychosocial stressors, and demographic information collected at baseline in pregnancy and infant age 3, 10, 19, months, 2 and 3 years, with measured length/height and weight. Multilevel modeling used to assess intervention impact on infant weight for length z-scores (WFLz). T tests and chi square used to assess impact on nutrition knowledge and practices. Logistic regression used to assess intervention dose on risk of obesity (BMI ≥ 95th% for age and sex) at age 3. Evaluation: Baseline prenatal assessments (n = 566) found high rates of maternal stress, obesity and unhealthy dietary practices. Five hundred and thirty three pregnant women randomized to StEP vs. standard care. No group differences in baseline mother/infant characteristics. Mean sessions attended by 3 years: 8.5 (range 1–15). At infant age 3 months: higher nutrition knowledge, higher rates of exclusive breastfeeding, tummy time and less early introduction of complimentary foods for intervention group. At 10 months, more exclusive breastfeeding, more responsive feeding styles and less introduction of juice. At age 2, more family meals and less restaurant food. Complete weight data available for infants through age 18 months (n = 433). Intervention group infants had lower mean WFLz between ages 12–18 months (-.21 (.10), p = .046). At 36 months, infants attending >10 sessions were less likely to have obesity, p = .039. Conclusions and Implications: Interventions like StEP have the potential to improve maternal infant feeding and activity practices and reduce childhood obesity. Funding: 2011-68001-30207.