The Effect of a Nursing Intervention on Birth Weight
Name: Victoria Ransom
Rank: LTC , USA
Organization: Henry M. Jackson Foundation
Performance Site: Walter Reed Army Medical Center, Washington, DC; National Naval Medical Center, Bethesda, MD; 89th Medical Group, Andrews AFB
Year Published: 1994
Abstract Status: Initial
Aggressive nursing intervention prenatally can be one of the most effective means of reducing preterm delivery rates and enhancing newborns' quality of life. Moore (1992) reported in her study of 891 women in the Northwest North Carolina Prevention of Prematurity Program (NNCPPP), that 15% of women who received the usual prenatal care offered high risk mothers delivered low birth weight (500-2,499 gram) infants, while 8% of women who received the usual care plus a specific nursing intervention delivered low birth weight infants. The purpose of this multi-site, tri-service replication study is to determine whether the same nursing intervention used by Moore, intensive telephone contact, will be associated with a reduced incidence of low birth weight (LBW) infants in a military population. Secondary objectives of this project include the study of (1) cost effectiveness of the intervention, (2) the correlation of LBW outcomes with specific associated etiologic factors, and (3) the effect of the intervention on state anxiety (STAI). A convenience sample will be recruited from all women receiving prenatal care during the seventh-month period at three military hospitals in the Washington, DC area. Women will be contacted during a prenatal visit between 24 and 28 weeks gestation to ask their permission for a project nurse to discuss the study with them. Women who consent to participate will be randomized to intervention and usual care groups. Both groups will be asked to complete the STAI at 24 and 28 weeks gestation. A sample of at least 730 participants, 365 in the intervention and 365 in the control group, will be obtained to provide the size determined by power analysis necessary to demonstrate a significant difference between groups. Achievement of the primary objective will be approached as a test of the hypothesis that women who receive the usual prenatal care and intensive telephone intervention will experience a lower incidence of LBW deliveries than women who receive only the usual care. Data will be analyzed using Fisher's Exact Test to compare the incidence of LBW between groups. Secondary objectives will be achieved by (1) comparing the cost of inpatient care between groups using the two-sample t-test (2) describing the incidence of specific etiologic factors associated with LBW between groups and (3) using analysis of variance to analyze the mean state anxiety scores as measured by the Spielberger State Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, and Cobbs, 1983) at 28 and 34 weeks gestation. Increased infant morbidity and mortality associated with LBW deliveries represent significant personal and productivity losses to military families, as well as major costs to the military health care system. Military treatment facilities spend more than $60 million annually to deal with the effects of preterm labor. One 25-week gestation infant can incur CHAMPUS costs well over $200,000 during its initial admission. This study proposes a cost-effective intervention which adds to current knowledge of preterm delivery prevention, focusing on improved quality and accessibility of care for military families.