Educational interventions to prevent paediatric abusive head trauma in babies younger than one year old: A systematic review and meta-analyses

Scott, Lauren J.; Wilson, Rebecca; Davies, Philippa; Lyttle, Mark D.; Mytton, Julie; Dawson, Sarah; Ijaz, Sharea; Redaniel, Maria Theresa; Williams, Joanna G.; Savović, Jelena

Abstract

Background: Paediatric abusive head trauma (AHT) occurs in young children due to violent shaking or blunt impact. Educational and behavioural programmes modifying parent/infant interactions may aid primary prevention. This systematic review aims to assess the effectiveness of such interventions to prevent AHT in infants. Methods: We searched Embase, MEDLINE, PsycINFO, The Cochrane library, CINAHL databases and trial registries to September 2021, for studies assessing the effectiveness of educational and behavioural interventions in preventing AHT. Eligible interventions had to include messaging about avoiding or dangers of infant shaking. Randomised controlled trials (RCTs) reporting results for primary (AHT, infant shaking) or secondary outcomes (including parental responses to infant crying, mental wellbeing), and non-randomised studies (NRSs) reporting primary outcomes were included. Evidence from combinable studies was synthesised using random-effects meta-analyses. Certainty of evidence was assessed using GRADE framework. PROSPERO registration CRD42020195644. Findings: Of 25 identified studies, 16 were included in meta-analyses. Five NRSs reported results for AHT, of which four were meta-analysed (summary odds ratio [OR] 0.95, 95 % confidence intervals [CI] 0.80–1.13). Two studies assessed self-reported shaking (one cluster-RCT, OR 0.11, 95 % CI 0.02–0.53; one cohort study, OR 0.36, 95 % CI 0.20–0.64, not pooled). Meta-analyses of secondary outcomes demonstrated marginal improvements in parental response to inconsolable crying (summary mean difference 1.58, 95 % CI 0.11–3.06, on a 100-point scale) and weak evidence that interventions increased walking away from crying infants (summary incidence rate ratio 1.52, 95 % CI 0.94–2.45). No intervention effects were found in meta-analyses of parental mental wellbeing or other responses to crying. Interpretation: Low certainty evidence suggests that educational programmes for AHT prevention are not effective in preventing AHT. There is low to moderate certainty evidence that educational interventions have no effect or only marginally improve some parental responses to infant crying.

• Journal Article Type: Article
• Acceptance Date: Oct 13, 2022
• Online Publication Date: Oct 26, 2022
• Publication Date: Dec 1, 2022
• Deposit Date: Oct 26, 2022
• Publicly Available Date: Oct 26, 2022
• Journal: Child Abuse and Neglect
• Print ISSN: 0145-2134
• Electronic ISSN: 1873-7757
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 134
• Pages: 105935
• DOI: https://doi.org/10.1016/j.chiabu.2022.105935
• Keywords: Psychiatry and Mental health; Developmental and Educational Psychology; Pediatrics, Perinatology and Child Health; Abusive head trauma; Shaken baby syndrome; Paediatric Infants; Systematic review; Meta-analysis
• Public URL: https://uwe-repository.worktribe.com/output/10106559
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0145213422004690?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Educational interventions to prevent paediatric abusive head trauma in babies younger than one year old: A systematic review and meta-analyses; Journal Title: Child Abuse & Neglect; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.chiabu.2022.105935; Content Type: article; Copyright: © 2022 The Author(s). Published by Elsevier Ltd.