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Table 14.32 Educational Programs Designed to Reduce the Risk of Shaken Baby Syndrome

Author Year

Country

Study Design

Sample Size

Methods Outcomes
Period of PURPLE Crying Prevention Intervention

Fujiwara et al.

(2012)

Japan

RCT

PEDro=7

NInitial=230, NFinal=201

 

Population: PURPLE (n=105): Gender: Male=0, Female=105. Control Group (n=96): Gender: Male=0, Female=96.

Intervention: Mothers of newborn infants were randomly assigned to receive the Period of PURPLE Crying prevention package consisting of a DVD and an 11-page booklet, or a DVD on injury prevention as part of a control group. All mothers completed a 4-day diary of the infant’s behaviours at 6 wk post-birth followed by a telephone survey at 2 mo. Mothers’ knowledge of crying and shaking, and their behavioural responses to stressful situations were assessed post treatment.

Outcome Measures: Baby Day Diary (BDD), Telephone Survey.

   

1.       Mothers who received the PURPLE intervention scored significantly higher on the Crying Knowledge scale of the telephone survey than the control group (p=0.004) but no significant differences were reported between groups for Shaking Knowledge (p=0.510).

2.       Walking away from the infant during inconsolable crying was reported significantly more often within the PURPLE group compared to the control group (p=0.040).

3.       The percentage of mothers who shared the advice of walking away during inconsolable crying with other caregivers was significantly higher for the PURPLE group compared to the control group (p=0.001) but sharing advice with other caregivers on the dangers of shaking a baby and infant crying did not differ significantly between groups (p=0.950 and p=0.870 respectively).

4.       No significant differences were found between groups for duration of contact with child when distressed (p=0.280), picking-up the infant when distressed (p=0.380), and daily frustration scores (p=0.190) according to BDD entries.

Barr et al. (2009)

USA

RCT

PEDro=5

N=2738

 

Population: PURPLE (n=1374): Gender: Male=0, Female=1374. Control Group (n=1364): Gender: Male=0, Female=1364.

Intervention: Mothers of newborn infants were randomly assigned to receive the Period of PURPLE Crying prevention material package consisting of a DVD and an 11-page booklet, or a DVD on injury prevention and two brochures as part of a control group. All mothers completed a 4-day diary of the infant’s behaviours at 5 wk post-birth followed by a telephone survey at 2 mo. Mothers’ knowledge of crying and shaking, and their behavioural responses to stressful situations were assessed post treatment.

Outcome Measures: Baby Day Diary, Telephone Survey.

   

1.       Mothers who received the PURPLE intervention scored higher on the Crying Knowledge and Shaking Knowledge scales of the telephone survey compared to the control group.

2.       The percentage of mothers in the PURPLE group who shared advice with other caregivers about walking away during inconsolable crying (6.5%) and the dangers of shaking (5.6%) was greater than the control group but no between group difference was found  for sharing advice on infant crying.

3.       Responses to crying scores on the telephone survey were higher (improved) in the PURPLE group for crying, inconsolable crying, and self-talk compared to the control group but no significant difference was reported.

4.       The PURPLE group documented significantly more infant distress in the BDD with a mean of 13.8min more time distressed compared to the control group (p<0.050).

Barr et al. (2009)

Canada

RCT

PEDro=9

N=1833

 

Population: PURPLE (n=649): Gender: Male=0, Female=649. Control Group (n=630): Gender: Male=0, Female=630.

Intervention: Mothers of newborn infants were randomly assigned to receive the Period of PURPLE Crying prevention material package consisting of a DVD and an 11-page booklet, or a DVD on injury prevention and two brochures as part of a control group. All mothers completed a 4-day diary of the infant’s behaviours at 5 wk post-birth followed by a telephone survey at 2 mo. Mothers’ knowledge of crying and shaking, and behavioural responses to stressful situations were assessed post treatment.

Outcome Measures: Baby Day Diary (BDD), Telephone Survey.

   

1.       Mothers who received the PURPLE intervention scored significantly higher on the Crying Knowledge scale of the telephone survey than the control group (p<0.001) but no significant differences were reported between groups for Shaking Knowledge (p=0.200).

2.       Mothers in the PURPLE group were significantly more likely to walk away during inconsolable crying than the control group (p=0.010).

3.       The percentage of mothers who shared advice with other caregivers about walking away during inconsolable crying, the dangers of shaking (both p<0.001), and infant crying (p=0.010) was significantly higher for the PURPLE group compared to the control group.

4.       No significant differences were found between groups for duration of contact with child when distressed (p=0.360), picking-up the infant when distressed (p=0.830), or daily frustration scores (p=0.260) according to BDD entries.

5.       A significant positive association was found between Crying Knowledge and a greater level of interaction with the PURPLE package (p=0.020).

Reese et al. (2014)

USA

Post-Test

NI=211, NF=68

Population: Mean Age=28.1yr; Gender: Male=0, Female=211.

Intervention: Mothers of newborn infants were provided with the Period of PURPLE Crying prevention education session from a nurse along with a 10-min DVD to take home and an 11-page booklet. Assessments were conducted at 2 mo follow-up.

Outcome Measures: Custom Knowledge Scale on the Dangers of Shaking, Coping and Soothing Techniques, Crying.

1.       On the crying subscale, 39 of 68 (57.4%) of mothers achieved a perfect score.

2.       On the shaking subscale, 65 of 68 (95.6%) of mothers achieved a perfect score.

3.       A total of 40 of 68 (58.8%) mothers attempted soothing behaviours and 35 of 68 (51.5%) were able to recall such behaviours.

4.       A total of 18 of 68 (26.5%) mothers attempted coping behaviours and 28 of 68 (38.2%) were able to recall such behaviours.

5.       Higher education was significantly associated with a perfect score on overall knowledge (p=0.020), knowledge of normal infant crying (p=0.007) and an increase in ability to recall one or more techniques for coping with infant crying (p=0.010).

Simonnet et al. (2014)

France

Pre-Post

N=190

Population: Mothers (n=186): Mean Age=30.9yr. Fathers (n=90): Mean Age=33.5yr.

Intervention: Parents of newborn infants received a short informative talk from a maternity department pediatrician and a pamphlet on abusive head trauma. The intervention was approximately 3 min in length. Assessments were completed at baseline and at 6wk follow-up.

Outcome Measures: Custom Multiple-Choice Questionnaire on Crying and Abusive Head Trauma.

1.       Mothers provided significantly more correct answers post-intervention compared to baseline on four of five questions (all p<0.001).

2.       Fathers also provided more correct answers post-intervention on four of five questions but statistical analyses were not completed due to a low number of fathers participating.

3.       Fathers demonstrated greater improvement in knowledge than mothers with a mean knowledge improvement score of 1.58 compared to 1.19.

Altman et al. (2011)

USA

Case Series

N=65,663

Population: 19 hospitals and 1 tertiary care center.

Intervention: Participants were parents who had a baby at one of the included hospitals from 2000-2008. In 2005 the program was implemented, and after that participants received a brochure and an 8 min educational video with information on abusive head trauma and prevention. Rate of shaking injuries were examined in the 3 yr period following the educational video and compared to the 5 yr period prior to intervention.

Outcome Measure: Rate of Injuries.

1.       Over the 8 yr study period a total of 16 infants in the region were treated for shaking injuries.

2.       Of the 16 injuries, 14 were born in the 5 yr period prior to the introduction of the educational video and 2 were born in the 3 yr period after the educational video was introduced.

3.       There was a significant reduction in injuries per year in the 3 yr period compared to the 5 yr period (p=0.030).

Bechtel et al. (2011)

USA

Case series

N=222

Population: Caregiver’s; Take 5 Safety Plan for Crying (n=112): Mean Age=25.2yr; Gender: Male=8, Female=104. Historical Control Group (n=110): Mean Age=25.7yr; Gender: Male=23, Female=87.

Intervention: Researchers examined the effects of a previously implemented educational program, in which parents received a brochure on steps to take when an infant is crying. Follow-up interviews were conducted after the educational program was implemented and compared to interviews from the CG group prior to the educational program.

Outcome Measures: Rate of Frustration, Infant Shaking, and Knowledge of Shaken Baby Syndrome (SBS).

1.       Parents in the intervention group were more likely to take a break if frustrated with a crying infant (OR 3.10) and were more likely to state frustration caused infant shaking (OR 2.21).

2.       Caregivers in the intervention group were more likely to state their knowledge of SBS was derived from hospital staff (OR 3.39).

Deyo et al. (2008)

USA

Pre-Post

N=7051

 

Population: Mean Age=28yr; Gender: Male=0, Female=7051.

Intervention: Mothers of newborn infants completed a pre-test of their knowledge of SBS before watching a short video and reviewing educational materials as part of the “Love me… Never shake me” program. After watching the video, the mothers completed a post-test. The intervention was provided only once and all mothers received a follow-up telephone call 3-4mo after participating in the program to test for retention. Assessments were conducted at baseline, post-treatment and 3-4mo follow-up.

Outcome Measure: Custom Questionnaire Regarding SBS Knowledge.

1.       A statistically significant increase in mothers’ knowledge that it is okay to let an infant cry (p<0.050) was found of the post-test but no significant differences were found for any other questions.

2.       At follow-up, 97% of mothers correctly defined SBS and the physiological consequences of shaking a baby, and 94% reported that they knew what to do when feeling stressed.

3.       It was reported at follow-up that 62% of mothers did not receive any further information on SBS from their pediatricians.

Dias et al. (2005)

USA

Post-Test

N=65,205

 

Population: TBI.

Intervention: Parents of newborn infants were provided with a 1-page leaflet and watched an 11 min video about SBS before being asked to sign a commitment statement. The intervention was provided once only with a follow-up telephone call. Suspected cases of SBS were reviewed and cross-referenced with signed commitment statements. Assessments were conducted at 7 mo follow-up and annually by nursing managers.

Outcome Measures: Incidence of SBS, Annual Nursing Managers’ Survey.

   

1.       In comparing incident rates of SBS in the 6 yr prior to the study and during the study period of 66 mo, a significant reduction was reported with 41.5 cases per 100,000 prior compared to 22.2 cases per 100,000 during the study (p=0.017).

2.       When incidence rates were calculated based on year of birth instead of year of injury, a significant reduction for births during the study period was still found (p=0.022).

3.       There was no significant difference for the incidence of SBS when comparing infants with and without a signed commitment statement (p=0.830).

4.       At follow-up, only 27% of respondents discussed SBS in the annual survey completed by nursing managers, indicating that the 11 min videotape was not utilised frequently.