CONFERENCE PROCEEDING
Smoking cessation interventions to parents of neonates hospitalized in the Neonatal Intensive Care Units (NICU)
 
More details
Hide details
1
General and Maternity Hospital Helena Venizelou, Athens, Greece
 
2
Midwifery Department, University of West Attica, Athens, Greece
 
 
Publication date: 2023-10-24
 
 
Corresponding author
Maria Vlachou   

General and Maternity Hospital Helena Venizelou, Athens, Greece
 
 
Eur J Midwifery 2023;7(Supplement 1):A160
 
KEYWORDS
ABSTRACT
Introduction:
According to studies, infant exposure to tobacco smoke is associated with increased perinatal morbidity and mortality, placental disorders, preterm delivery, IUGR newborns, premature rupture of membranes, ectopic pregnancy, miscarriages,1-4 sudden infant death syndrome,5 low birthweight6. In addition, infants who live with smokers, during their childhood, may suffer from diabetes mellitus, obesity, hypertension, cancer,7-11 while during their first year of life, they may suffer from asthma, respiratory infections, recurrent wheezing,12 otitis media, colic, restless sleep, neurobehavioural disorders13-15. Preterm birth and NICU stay are stressful situations for parents. On the other hand, NICU admission may provide a unique condition for the immediate change in the parents’ smoking status as neonatal hospitalization has a positive effect on their embracing a smoking cessation intervention, taking into account their neonate’s health. Moreover, during the postpartum period, women often relapse into their previous smoking status, which is usually associated not only with stress and lack of social and medical support but also with cohabitation with a smoking partner. Due to all these, the breastfeeding rate is also affected. Educating the mother, the partner and all the caregivers will contribute to them not returning to their previous smoking status, to maintain a tobacco smoke free domestic environment, to improve infants, toddlers and young children’s health, to avoid re-admission to hospital, to reduce the cost of hospitalization as well as increasing the breastfeeding rates. Finally, it must be noted that new mothers who smoke are highly likely to show symptoms of depression, which may prevent the success of the smoking cessation intervention and lead to relapse into their previous smoking status16,17. Midwives are the health professionals who come into contact not only with women but the entire family during the antenatal period. More specifically, during the postpartum period, midwives provide women with counsel on a number of issues including both women’s and infants’ care and health as well as breastfeeding. Therefore, midwives develop a direct, close and durable relationship with women and their family, which makes them some of the most significant professionals capable of providing counselling with regards to smoking cessation and prevention of relapse, making use of well-grounded intervention techniques aiming at smoking cessation, after having been trained in the field. Research suggests that smoking cessation intervention conducted by midwives during the perinatal period has, in fact, high success rates18-20.

Material and Methods:
A targeted intervention will be implemented focused on the neonatal primary caregivers who smoke (or are passive smokers) and their neonates had to be admitted to NICU right after birth. The approach will take place between 1st and 3rd day of neonate’s life. During the first meeting, a midwife trained in smoking cessation will administer questionnaires (demographics etc.), and the Fagerstrom Test for Nicotine Dependence as well as recording smoking history. She will also provide information and self-help leaflets on smoking cessation, have the consent form signed, implement motivational interviewing and schedule the next meeting. In addition, emphasis will be placed on beginning, establishing and maintaining breastfeeding. Some of the tools that will be used include the smoking cessation consult form ‘TiTan Crete’ (University of Ottawa Heart Institute, 2015), the Edinburgh Postnatal Depression Scale (EPDS) and the 5As approach. There will be three follow-up meetings (on a weekly basis) during which smoking cessation intervention and assessment of the venture will take place. During the first three months of infant’s life, there will be a meeting (online, by phone or in-person during the NICU follow-up) so as to ascertain whether the change in smoking status is maintained after the infant has been discharged and has returned to the domestic environment. Also, relapse likelihood as well as second-hand and third-hand tobacco smoke exposure will be examined. The study sample will consist of Greek adult parents or different nationality parents who will have knowledge of the Greek language. The parents will be smokers (providing they smoke one cigarette on a daily basis, or have stopped smoking upon being informed about the pregnancy or one month earlier or a few days before) or passive smokers, their neonates will be born in the General and Maternity Hospital Helena Venizelou and will be admitted to the Neonatal Intensive Care Unit. Participants will be excluded from the study if they suffer from severe cognitive impairment or any other psychiatric disorder, which excludes them from the study protocol. The control group (same study inclusion criteria as the intervention group) will only be provided with printed information and self-help material on smoking cessation.

Results:
Through the smoking cessation intervention, smoking parents/main caregivers are expected to be supported and aided in quitting smoking so as to maintain a smoke free domestic environment and welcome their neonate after discharge from the NICU. Thus, the risk of smoking relapse is reduced and the infant’s health is promoted, as well as the parents’ and the family’s overall.

Conclusions:
Smoking parents and caregivers pose a serious threat to both their own and their infant’s health. Second-hand and third-hand tobacco smoke exposure will affect their infants’ life until they reach adulthood. Planning targeted smoking cessation interventions during the postpartum period may contribute to promoting the health of not only the entire family but also society as the health of the individual will be maintained at all stages of life (neonate, infant, child, adult) and the cost of pharmaceutical treatment and hospitalization in NICU and ICU will be reduced.

 
REFERENCES (20)
1.
Makin J, Fried PA, Watkinson B. A comparison of active and passive smoking during pregnancy: long-term effects. Neurotoxicol Teratol. 1991;13(1):5-12. doi:10.1016/0892-0362(91)90021-n
 
2.
Schoendorf KC, Kiely JL. Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics. 1992;90(6):905-908
 
3.
Drews CD, Murphy CC, Yeargin-Allsopp M, Decouflé P. The relationship between idiopathic mental retardation and maternal smoking during pregnancy. Pediatrics. 1996;97(4):547-553
 
4.
Wakschlag LS, Lahey BB, Loeber R, Green SM, Gordon RA, Leventhal BL. Maternal smoking during pregnancy and the risk of conduct disorder in boys. Arch Gen Psychiatry. 1997;54(7):670-676. doi:10.1001/archpsyc.1997.01830190098010
 
5.
DiFranza JR, Lew RA. Morbidity and mortality in children associated with the use of tobacco products by other people. Pediatrics. 1996;97(4):560-568
 
6.
Carmines EL, Rajendran N. Evidence for carbon monoxide as the major factor contributing to lower fetal weights in rats exposed to cigarette smoke. Toxicol Sci. 2008;102(2):383-391. doi:10.1093/toxsci/kfn009
 
7.
Ginzel KH, Maritz GS, Marks DF, et al. Critical review: nicotine for the fetus, the infant and the adolescent?. J Health Psychol. 2007;12(2):215-224. doi:10.1177/1359105307074240
 
8.
Jennings GE. A randomized clinical trial in a child health care setting comparing two brief interventions to reduce environmental tobacco smoke exposure. Oklahoma State University ProQuest Dissertations Publishing; 2007
 
9.
Sawnani H, Olsen E. The effect of in utero cigarette smoke exposure on development of respiratory control: A review. Pediatric Allergy, Immunology and Pulmonology. 2010;23(3):161-167
 
10.
Mendelsohn C, Gould GS, Oncken C. Management of smoking in pregnant women. Aust Fam Physician. 2014;43(1):46-51
 
11.
Holbrook BD. The effects of nicotine on human fetal development. Birth Defects Res C Embryo Today. 2016;108(2):181-192. doi:10.1002/bdrc.21128
 
12.
Lannerö E, Wickman M, Pershagen G, Nordvall L. Maternal smoking during pregnancy increases the risk of recurrent wheezing during the first years of life (BAMSE). Respir Res. 2006;7(1):3. doi:10.1186/1465-9921-7-3
 
13.
Kabir Z, Connolly GN, Alpert HR. Secondhand smoke exposure and neurobehavioral disorders among children in the United States. Pediatrics. 2011;128(2):263-270. doi:10.1542/peds.2011-0023
 
14.
A Longo C, A Fried P, Cameron I, M Smith A. The long-term effects of prenatal nicotine exposure on verbal working memory: an fMRI study of young adults. Drug Alcohol Depend. 2014;144:61-69. doi:10.1016/j.drugalcdep.2014.08.006
 
15.
Ekblad M, Korkeila J, Lehtonen L. Smoking during pregnancy affects foetal brain development. Acta Paediatr. 2015;104(1):12-18. doi:10.1111/apa.12791
 
16.
Stotts AL, Green C, Northrup TF, et al. Feasibility and efficacy of an intervention to reduce secondhand smoke exposure among infants discharged from a neonatal intensive care unit. J Perinatol. 2013;33(10):811-816. doi:10.1038/jp.2013.43
 
17.
Diamanti A, Raftopoulos V, Lykeridou A, Katsaounou P. Smoking and Pregnancy: Where are we now? An Update of the situation in Greece. International Journal of Caring Sciences. 2019;12(1):79
 
18.
Flemming K, Graham H, McCaughan D, Angus K, Sinclair L, Bauld L. Health professionals’ perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and during the post-partum period: a systematic review of qualitative research. BMC Public Health. 2016;16:290
 
19.
Bye A, Shawe J, Stephenson J, Bick D, Brima N, Micali N. Differences in pre-conception and pregnancy healthy lifestyle advice by maternal BMI: Findings from a cross sectional survey. Midwifery. 2016;42:38-45. doi:10.1016/j.midw.2016.09.013
 
20.
Forman J, Harris JM, Lorencatto F, McEwen A, Duaso MJ. National Survey of Smoking and Smoking Cessation Education Within UK Midwifery School Curricula. Nicotine Tob Res. 2017;19(5):591-596. doi:10.1093/ntr/ntw230
 
eISSN:2585-2906
Journals System - logo
Scroll to top