PM2052: Anticipatory Guidance Interventions on Newborn Care and Injury Prevention: A Systematic Review

Background: The American Academy of Pediatrics’ Bright Futures recommends providing routine anticipatory guidance starting at birth. Parents benefit from receiving preventative counseling about newborn care and safety precautions at this stage, as the birth of an infant can be a significant transition requiring immense attention and accommodation. While multiple strategies for delivering newborn anticipatory guidance have been implemented, efficacies of such methods have not yet been compared systematically.

Objective: To perform a systematic review on the effects of anticipatory guidance interventions on caregiver knowledge, healthcare utilization, and newborn injury incidence.

Methods: We included English-language peer-reviewed studies published 2011 to 2021 from PubMed, EMBASE, and CINAHL that focused on anticipatory guidance delivered to caregivers of newborns aged 0 to 1 month of life. Two reviewers independently screened studies by titles and abstracts and reviewed full texts of eligible articles. Selected studies underwent data extraction and quality appraisal using a predefined extraction form, the Risk Of Bias In Non-randomized Studies of Interventions tool, and the revised Cochrane risk-of-bias tool for randomized trials 2.0.

Results: We screened 2,384 studies and included 20 articles. Four articles were randomized clinical trials and 16 were nonrandomized studies. The articles were grouped based on the focus of anticipatory guidance: 17 studies focused on abusive head trauma (AHT) prevention, two about general anticipatory guidance, and one about breastfeeding practices. Interventions varied in the learning materials used, setting, and personnel involved. Studies reported significant increases in some domains of caregiver knowledge, coping behaviors, and satisfaction. There are limited data that newborn anticipatory guidance decreases unscheduled healthcare utilization of outpatient and emergency services. Studies examining incidence of AHT injuries after state-wide interventions had mixed results. 18 studies received scores of serious overall risks of bias or higher, and two studies had a moderate overall risk of bias.

Conclusion: Newborn anticipatory guidance significantly improves parent satisfaction and confidence. There is evidence suggesting that educational interventions improve caregiver knowledge about newborn care and reduce caregiver healthcare utilization. Reductions in AHT incidence were observed but are inconclusive given high risks of bias . Generally, the included studies had moderate to critical overall risk of bias, indicating significant methodologic limitations. Feasibility of more scientifically rigorous studies on anticipatory guidance is difficult due to design limitations and low incidence of AHT. Comparison of interventions across studies is incomplete due to different intervention designs and heterogenous outcome measures. Future research may benefit from using standardized metrics of knowledge and patient outcomes whenever possible.