This project aims to strengthen the emotional bond between infants and their caregivers, reduce parental stress and stimulate caretaking practices to promote the development of premature babies born at the Sofia Feldman Hospital.
The innovation plans to introduce a strategy into routine care at the Casa do Bebê to recognize behaviors and individuality of the baby. This strategy, known as the Newborn Behavior Observation, will favor engagement and work to increase self-confidence in the parents. Parents will also participate in individual sessions, built to help parents understand their babies’ needs and how to deal with them. In addition, they will be expected to participate in two workshops to build a portfolio, where they will have the opportunity to express their feelings concerning their baby’s achievements and their expectations about their child’s future.their wishes and expectations.
- 50% reduction in the risk of preterm children experiencing developmental delay.
- 50% of the primary caregivers will feel less stressed and more confident after being trained in the intervention.
- 25 health care workers will be trained to deliver the intervention.
- 200 mothers and 100 fathers will receive intervention.
This project will provide an intervention for families of premature babies who were referred to Casa do Bebê at the Sofia Feldman Hospital (HSF). The Casa do Bebê is a support house neighboring HSF, where preterm born babies stay with their mothers when they are stable and not requiring services at HSF, until they are well enough to be discharged. Currently, families do not receive extensive programming during their stay at the support house.
The goal of the study is to implement a program at Casa do Bebê that strengthens the bond between the family and the child, through helping families recognize the babies’ potential, and reducing parental stress.
During individual sessions with trained staff members, families will be taught skills part of the Newborn Behavior Observation  strategy to help them to understand their babies’ needs and how to address them.
Each mother/family will also participate in at least two workshops to build a portfolio on their babies. These portfolios will serve as an opportunity for parents to express their feelings concerning their babies, such as expectations, fears, desires, etc. The portfolio will record the parents’ desires, expectations, and developmental milestones for their infant through sewing, painting and other cultural outlets.
Some community volunteers will be invited to participate in the workshops. Other family members may also participate, which will lead to increased social support and reduction of maternal stress.
After staying at the Casa do Bebê for about seven days, the infants and their families will be followed up at 2, 4, 6, 9 and 12 months of age, and the team will monitor their health and development at the outpatient clinic. At each visit, families will receive new recommendations on how to promote the health and development of the infants. There will be activities that will allow families to recognize the babies’ achievements and express their anxieties. Furthermore, at each follow-up visit, families will be encouraged to review their portfolio, and continuing recording the baby’s progress.
Project team motivated
There is a team motivated, with expertise on the subject and large enough to carry out the proposed activities.
Proposed intervention will have positive benefits for children/families, but for health services and providers as well, encouraging their adherence and support of the project.
Achievable sample size for demonstrable impact
The sample size needed to demonstrate the impact of interventions is possible to be achieved with the inclusion of children in the Casa do Bebê and the ACRIAR during 6 months.
Families unable to travel to follow-up appointments
Most families live in very small cities around the city and are unable to travel due to their poor socioeconomic conditions. A strong active search scheme and transport will be offered to families that require the services, to support their adherence and follow-up.
High turnover of health workers
The high turnover rate of hospital health workers is a serious challenge for the program. To overcome this, it will be necessary to negotiate with the hospital board, highlighting the benefits of change, aligned with their vision as well. It is likely that new training workshops will need to occur to mitigate this problem.
The intervention model will be extended to the neonatal unit and the ACRIAR clinic of the Hospital das Clínicas, during the course of the grant. If efficiency is demonstrated, the model will be presented to other similar settings around the Minas Gerais State.
The program will use a randomized control trial to evaluate impact of the intervention.
Evaluation impact for mothers
All mothers will complete a structured questionnaire upon arrival at Casa do Bebe. The questionnaire will cover topics such as pregnancy, childbirth, socioeconomic and demographic factors. Maternal depression symptoms and parental stress will also be evaluated.
Aside from different assessments used to assess parent knowledge and behavior (see resource section), family interactions will be videotaped at 6 months and evaluated for quality of interaction.
- At the visits which occur when the child is 6 and 12 months, families will be tested for parental practices23, parenting stress,  and toddler socioemotional development5
- At 6 months, the family will be videotaped presenting a novel toy to the infant to evaluate the quality of the interaction between mother and child. A sample of 20% of the videos will be randomly selected to be coded.
- At the 9-month home visit, families will be tested to assess stressful events,  such violence, and the home environment. 
Infant health and nutrition will be monitored by the indices of weight, height, cephalic perimeter and cutaneous folds for the corrected gestational age.
Development will be monitored using scales validated for the Brazilian population. [8, 9]
- The Newborn Behavioral Observations system: What Is It? The Brazelton Institute.
- Cox JL, et al. (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 150:782-6.
- Martins GDF, et al. (2010) Construção e validade da Escala de Crenças Parentais e Práticas de Cuidado (E-CPPC) na primeira infância. Psico USF: 15(1), p.23-34
- Norbeck JS, et al. (1981) The development of an instrument to measure social support. Nursing Research:30, 264-269
- Abidin RR. (1995) Parenting Stress Index: Professional Manual. Ed 3rd. Psychological Assessment Resources I, editor. Odessa, FL.
- Briggs-Gowan M, Carter A. BITSEA, Brief Infant –Toddler Social Emotional Assessment. Examiner’s manual. Massachusetts: Yale University and the University of Massachusetts; 2006
- Sarason I G, et al. (1978) Assessing the impact of life changes: Development of the Life Experiences Survey. J Cons and Clinical Psy: 46, 932-946
- Bradley R, et al. (1994) Early Indications of Resilience and Their Relation to Experiences in the Home Environments of Low Birthweight Premature Children Living in Poverty. Child Development; 65:346–60.
- Fernandes LV, et al. (2012) Neurodevelopmental assessment of very low birth weight preterm infants at corrected age of 18-24 months by Bayley III scales. J Pediatr. 88(6):471-8
- Sheldrick RC, et al. (2013) Evidence-based milestones for surveillance of cognitive, language, and motor development. Academic pediatrics; 13(6):577–86
Instruments & Batteries