Intervenção promotora de parentalidade para mães de bebês nascidos pré-termo: ensaio clínico randomizado

Abstract

Maternal parental self-efficacy perception is a strong predictor of positive parenting practices with newborns. Early interventions that provide positive feedback can improve this perception in mothers of premature infants, promoting healthier neonatal behaviors and strengthening the mother-infant bond. This study aimed to evaluate the effects of a positive video feedback intervention to promote parenting in mothers of preterm newborns, focusing on maternal parental self-efficacy perception and their children’s behavior. Randomized, triple-blind clinical trial with two groups: Control Group (CG) and Intervention Group (IG), conducted at a referral maternity hospital in Fortaleza, CE, from October 2022 to February 2024. The sample, calculated using G*Power 3.1.9.2, consisted of 66 mother-infant dyads, 33 in each group. Inclusion criteria: mothers with infants in the Kangaroo Intermediate Neonatal Care Unit (UCINCa), babies born between 28 and 36 weeks and 6 days, with corrected gestational age between 36 weeks and 3 months, and clinically stable on the day of data collection. Exclusion criteria: mothers with cognitive limitations or psychiatric disorders, and infants who were twins of a participant. Randomization was conducted in blocks, using opaque and sealed envelopes. In the pre-test, the dyad form, the Maternal Parental Self-Efficacy Perception Scale (PAEPM), and the Neonatal Behavioral Observation (NBO) scale were applied, the latter also being recorded on video. Mothers received feedback on their babies’ behavioral responses with guidance. Mothers in the CG received standard guidance (kangaroo positioning), while those in the IG received standard guidance combined with the promotion of parental self-efficacy, based on the results of the applied scales. After 4–7 days, the PAEPM and NBO were reapplied (post-test). The independent variable was the positive feedback intervention. Outcome variables included PAEPM and NBO scores. Data were analyzed using chi-square, Fisher’s exact test, Mann-Whitney, paired t-test, and Wilcoxon tests. Regression analysis with a mixed-effects model considered the deltas of the PAEPM and NBO scales. The study was approved by the Research Ethics Committee of the host institution and by the Brazilian Registry of Clinical Trials (ReBEC), number RBR-2skzz8s. No significant differences were observed between the groups in terms of social and economic characteristics. The highest increases in post-test PAEPM scores were observed in mothers living in rural areas (p=0.031), without paid employment (p=0.049), aged 15 to 19 years (p=0.007), and with only one child (p=0.004). Both interventions demonstrated a positive impact over time (CG and IG with p<0.001). The group effect on the post-test PAEPM results was significant in the factors Eliciting Behaviors (p<0.001), Reading Behavior (p<0.001), and in the total score of the scale (p=0.001). In the NBO post-test results, the group effect was significant in the autonomic (p=0.030), motor (p<0.001), and responsiveness (p<0.001) domains. Positive feedback strategies for promoting maternal parental self-efficacy, when combined with conventional care models, improve maternal confidence in their ability to care for their baby and positively reflect on the behavior of preterm newborns. These results may influence public policies and health promotion practices focused on neonatal nursing care and parenting, offering continuous and centralized support to families.