L'alito del bambino del progetto: uno studio pilota per ridurre l'esposizione al fumo passivo in alto neonati rischio respiratorie nella terapia intensiva neonatale

The adverse effects of secondhand smoke exposure (SHSe) in children are well documented and include higher risks of respiratory illnesses, asthma, middle ear disease and SIDS. Infants admitted to a neonatal intensive care unit (NICU) are particularly vulnerable to the effects of SHSe, typically exhibiting respiratory or chronic lung conditions prior to discharge. The primary aim of this investigation is to test the feasibility and efficacy of a hospital-based, motivational interviewing intervention for reducing SHSe in a low-income, multi-ethnic population of NICU infants, with followup at 1, 3, and 6 months post-discharge. A total of 144 families with an infant at high respiratory risk in the NICU who reported at least one smoker in the household were randomized to MI, Usual Care (UC), or Usual Care with Reduced Measurement (UC-RM; abbreviated baseline and no 1 or 3 month assessments were conducted). The MI intervention included two 30-45 minute counseling sessions in the NICU. Outcomes included self reported smoking in the home via Timeline Followback (TLFB) and air nicotine monitors. Of the 947 families approached in the NICU, 26% reported a household smoker in the home, 20% refused to participate in the study and another 8% failed to attend the baseline assessment. Six infants died prior to randomization. Of the MI participants, 86.4% attended Session 1, and only 71.2% attended both sessions. At 6-months post discharge, according to TLFB and monitor data, 51.4% and 58.8% of the MI and UC homes were smoke-free, respectively. However, only 37.5% of the UC-RM group had smoke-free homes. We conclude that recruitment and intervention with NICU parents in a SHSe study is feasible, although improvements are needed. MI as implemented did not increase effects over assessment alone. Thus, assessment and discussion of SHSe in the NICU may increase the likelihood of a smoke-free home post-discharge, yet more intensive intervention is needed to strengthen effects. Effective interventions to reduce SHSe in households with NICU infants at high respiratory risk could result in substantial decreases in adverse health effects and the very large associated costs. This study was supported by grant R40MC08962 through the U.S. Department of Health and Human Services, Maternal and Child Health Research Program.