Presented at the Neonatal Society Spring Meeting 2019.

Authors: Harriet Hunt, Rebecca Abbott, Kate Boddy, Rebecca Whear, Alison Bethel, Sue Prosser, Andrew Collinson, Jennifer Kurinczuk, Christopher Morris, Leanna Wakely, Jo Thompson Coon

Institution(s)
University of Exeter; Supporting Neonatal Users and Graduates (SNUG); Royal Devon and Exeter Hospital; Royal Cornwall Hospital, Treliske; National Perinatal Epidemiology Unit, University of Oxford

Introduction
Parents of babies admitted to neonatal units experience an arduous emotional journey which may lead to anxiety, depression and post-traumatic stress and can persist long after discharge from the unit. Support from a parent with first-hand experience able to empathise with problems and challenges may help. This systematic review identified the quantitative and qualitative evidence that explored the experiences and effects of parent to parent (P2P) support, from the perspective of those giving, receiving, or implementing it.

Methods
We worked with a Parent Advisory Group (PAG) of parents with relevant and varied lived experience of having a baby in neonatal care and experience of providing peer support. Using best practice, we undertook a systematic review of P2P support. Thirteen electronic databases were searched and independent double screening and quality appraisal was undertaken. Studies were included if they described the effects or experiences of P2P support. We excluded studies relating to interventions delivered by professionals offering instruction or training to parents rather than support. The protocol was registered: PROSPERO CRD42018090569.

Results
The search identified 4593 records. After abstract and full text screening, 15 papers from 14 studies were included: 7 quantitative and 8 qualitative. No studies from the UK were found: 6 were from Canada, 8 from the USA and 1 from Finland. Quality of the evidence was mixed, with few studies rated as high quality. Ten studies related to general P2P support, and 5 related specifically to breastfeeding. Quantitative outcomes were grouped into 5 categories: psychological, perceptions of care and support, interaction and parenting behaviours, knowledge and understanding, and breastfeeding rates and attitudes. P2P support was found to increase perceptions of support, reduce maternal stress, and increase maternal confidence in the ability to care for their baby. From the qualitative data, 26 sub-themes (e.g. shared experience, reassurance and non-judgmental understanding) were identified resulting in 4 main themes: trust, hope, information, and connecting. Few negative experiences or outcomes were reported, and data on the experiences of fathers was lacking.

Conclusions
Whilst the rich qualitative evidence suggested mostly positive experiences from all perspectives of P2P support, robust trial evidence for this was lacking. Furthermore, the difference in models for implementing P2P support meant we were unable to draw solid recommendations to guide best practice.

References
This research was funded by the Research for Patient Benefit (RfPB) Programme ref. PB-PG-0416-20032,and supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care

Senior author supporting presentation on day of meeting: Rebecca Abbott

Corresponding author e-mail address: h.a.hunt@exeter.ac.uk