Effectiveness of the nurse-led multi-component BRIDGE program on maternal competence and selected post-discharge outcomes of preterm babies: A randomized controlled trial

Abstract

Background: Mothers require sufficient knowledge and skill in caring for a preterm newborn at home after discharge. Infant weight gain and other health parameters can be used to assess the quality of care received. A comprehensive early intervention program can help mothers through this transitional period.

Objective: To examine the effect of the BRIDGE Program versus standard care in improving maternal competence and the selected post-discharge outcomes of preterm newborns admitted to the tertiary-level hospital in India.

Methods: We conducted a single-blinded, two-arm, randomized controlled trial with a repeated measures design. Participants were recruited from a tertiary-level multi-specialty medical college hospital and research center in Vijayapur, India. Overall, 110 preterm babies aged 32 to 37 weeks of gestation and their mothers were randomly allocated to either intervention or control group (55 preterm infants and mother dyad in each group). The BRIDGE program included five phases: (I) family-centered health education on prematurity and preterm care; (II) demonstrations of preterm care procedures such as breastfeeding and burping techniques, kangaroo mother care, oil massage, and so on; (III), a home care guide on DO.s and DON'Ts of preterm care; (IV) a home visit on first day of discharge; and (V) digital based follow-up through video call for one-week post-discharge. Outcomes were measured in terms of mothers' competence, preterm newborn weight gain, hospital readmission rate, and neonatal death up to one month after discharge. Data on mothers' competence in preterm care was collected at baseline and 7th-day post-discharge of preterm infants. For newborns, measurements were taken at baseline, discharge, seventh-day post-discharge, 15th-day post-discharge, and 30th-day post-discharge.

Results: After the BRIDGE program intervention, mean knowledge (95 % CI = 23.96-24.57) and skill (95 % CI = 14.02-14.69) scores of mothers in the intervention group has improved significantly than the control group (knowledge: 95 % CI = 18.20-20.60; and skill: 95%CI = 9.96-11.66). Preterm infants exposed to the BRIDGE program weighed 130 g and 790 g more than controls on days 15 and 30 after discharge (p = 0.016). However, no statistically significant differences were observed in readmission rate and post-discharge mortality of preterm infants (p > 0.05).

Conclusions: Although the BRIDGE program did not affect preterm infants' outcomes, the components of the intervention such as education, home visits, and digital follow-up empowered mothers allowing them to thrive in their surroundings and experience fewer consequences in newborn care.

Registration: The study was registered at the Clinical Trial Registry of India (Trial No. CTRI/2021/03/032349), and data was gathered between August 2021 and October 2022.

Tweetable abstract: The BRIDGE program to bridge the care of preterm from hospital to home setting can enhance mothers' competence and babies' growth in their environment.

Keywords: Continuity of care; Hospital readmission; Mortality; Mothers' ability; Nurse-led intervention; Premature babies; Weight gain.