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Question of the week · NICU this week, issue 3

A neonatal unit with an established developmental care programme and psychology support introduces a one-off video-feedback session for mothers of babies born at 28 to 32 weeks' gestation. All mothers receive the session. When their babies reach six months corrected age, the mothers' anxiety and depression scores are lower than at enrolment and their parenting self-efficacy scores are higher. What is the most likely explanation for these changes?

You chose E. The best answer is B.

  1. AThe video-feedback session has produced a lasting improvement in maternal mental health
  2. BMothers typically improve over this period with good routine care, so the change cannot be attributed to the sessionBest answer
  3. CThe questionnaires are not valid in mothers of preterm babies, so the scores are unreliable
  4. DThe babies' temperament has become easier over the first months, reducing maternal stress
  5. EMothers who improved were more likely to return questionnaires, which fully explains the change

Why

Without a comparison group, a before-and-after improvement cannot be credited to an intervention. Distress after a preterm birth often eases as the baby stabilises, goes home and the mother gains experience, especially when routine support is good. In a randomised trial of this kind of single session, maternal self-efficacy rose and anxiety and depression scores fell over time in both the intervention group and the routine-care group, with no difference between them. Option D is tempting but wrong: parent-reported infant temperament scores became more challenging over time, reflecting normal development, not easier. Questionnaire validity and non-response can bias results, but they do not explain an improvement that is equally seen in controls. This is the Joint observation in NICU (JOIN) trial (PLOS ONE, 2024), a single-centre study in a largely low-risk population. It was underpowered for small effects, so a modest benefit cannot be excluded.

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