Early Intervention Improves Cognitive Outcomes for Preterm Infants: Randomized Controlled Trial

OBJECTIVE: The goal was to examine the effectiveness of an early intervention on cognitive and motor outcomes at corrected ages of 3 and 5 years for children with birth weights (BWs) of <2000 g. METHODS: A randomized controlled trial of a modified version of the Mother-Infant Transaction Program was performed. Outcomes were assessed with the Bayley Scales of Infant Development II and the Wechsler Preschool and Primary Scale of Intelligence-Revised at 3 and 5 years, respectively. McCarthy Scales of Children's Abilities and the grooved pegboard test were used to test motor outcomes at 5 years. RESULTS: A total of 146 infants were assigned randomly (intervention group: 72 infants; control group: 74 infants). The mean BWs were 1396 ± 429 g for the intervention group and 1381 ± 436 g for the control group. After adjustment for maternal education, a nonsignificant difference in Mental Developmental Index scores at 3 years of 4.5 points (95% confidence interval: −0.3 to 9.3 points) in favor of the intervention group was found, whereas the intervention effect on full-scale IQ scores at 5 years was 6.4 points (95% confidence interval: 0.6–12.2 points). Significantly more children in the intervention group had IQ scores of ≥85 at 3 and 5 years. There were no differences between the groups with respect to motor outcomes. CONCLUSION: This modified version of the Mother-Infant Transaction Program improved cognitive outcomes at corrected age of 5 years for children with BWs of <2000 g.

[1]  A. Beelen,et al.  A neurobehavioral intervention and assessment program in very low birth weight infants: outcome at 24 months. , 2010, The Journal of pediatrics.

[2]  S. le Cessie,et al.  Effects of Individualized Developmental Care in a Randomized Trial of Preterm Infants <32 Weeks , 2009, Pediatrics.

[3]  Betty R. Vohr,et al.  Beneficial Effects of Breast Milk in the Neonatal Intensive Care Unit on the Developmental Outcome of Extremely Low Birth Weight Infants at 18 Months of Age , 2006, Pediatrics.

[4]  L. Doyle,et al.  Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants. , 2008, The Cochrane database of systematic reviews.

[5]  I. White,et al.  Randomised trial of a parenting intervention during neonatal intensive care , 2007, Archives of Disease in Childhood Fetal and Neonatal Edition.

[6]  D. Pederson,et al.  Maternal emotional responses to preterm birth. , 1987, The American journal of orthopsychiatry.

[7]  J. Pinelli,et al.  Developmental care for promoting development and preventing morbidity in preterm infants. , 2006, The Cochrane database of systematic reviews.

[8]  L. B. Dahl,et al.  A Randomized, Controlled Trial of the Effectiveness of an Early-Intervention Program in Reducing Parenting Stress After Preterm Birth , 2006, Pediatrics.

[9]  L. Papile,et al.  Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. , 1978, The Journal of pediatrics.

[10]  A. Kaufman,et al.  Comparison of normal and minimally brain dysfunctioned children on the McCarthy Scales of Children's Abilities. , 1974, Journal of clinical psychology.

[11]  J. Magill-Evans,et al.  Parent-Child Interactions and Development of Toddlers Born Preterm , 1999, Western journal of nursing research.

[12]  Anne Martin,et al.  Early Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program , 2006, Pediatrics.

[13]  A. Moessinger,et al.  Early Dyadic Patterns of Mother–Infant Interactions and Outcomes of Prematurity at 18 Months , 2006, Pediatrics.

[14]  M. Preyde,et al.  Effectiveness of a parent "buddy" program for mothers of very preterm infants in a neonatal intensive care unit. , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[15]  C. Bonnier Evaluation of early stimulation programs for enhancing brain development , 2008, Acta paediatrica.

[16]  N Marlow,et al.  Neurocognitive outcome after very preterm birth , 2004, Archives of Disease in Childhood - Fetal and Neonatal Edition.

[17]  L. B. Dahl,et al.  Joint attention in term and preterm infants at 12 months corrected age: the significance of gender and intervention based on a randomized controlled trial. , 2006, Infant behavior & development.

[18]  N. Marlow,et al.  Randomised trial of parental support for families with very preterm children: outcome at 5 years , 2005, Archives of Disease in Childhood.

[19]  Mark Schluchter,et al.  Poor Predictive Validity of the Bayley Scales of Infant Development for Cognitive Function of Extremely Low Birth Weight Children at School Age , 2005, Pediatrics.

[20]  C. Robertson,et al.  Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis , 2009, Journal of Perinatology.

[21]  J. Flynn,et al.  Group differences: is the good society impossible? , 1996, Journal of Biosocial Science.

[22]  L Beckwith,et al.  Preterm children at early adolescence and continuity and discontinuity in maternal responsiveness from infancy. , 1992, Child development.

[23]  L. B. Dahl,et al.  A randomized study of the impact of a sensitizing intervention on the child-rearing attitudes of parents of low birth weight preterm infants. , 2010, Scandinavian journal of psychology.

[24]  G. Escobar,et al.  SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. , 2001, The Journal of pediatrics.

[25]  L. B. Dahl,et al.  A randomized controlled trial of an early intervention program in low birth weight children: outcome at 2 years. , 2008, Early human development.

[26]  the Swiss Neonatal Network The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units , 1993, The Lancet.

[27]  Björn Westrup,et al.  Newborn Individualized Developmental Care and Assessment Program (NIDCAP) - family-centered developmentally supportive care. , 2007, Early human development.

[28]  L. Doyle,et al.  Do early intervention programmes improve cognitive and motor outcomes for preterm infants after discharge? A systematic review , 2009, Developmental medicine and child neurology.

[29]  L. Zahr,et al.  Comparing the Effects of Neonatal Intensive Care Unit Intervention on Premature Infants at Different Weights , 1992, Journal of developmental and behavioral pediatrics : JDBP.

[30]  H. Gjessing,et al.  Birthweight by gestational age in Norway , 2000, Acta obstetricia et gynecologica Scandinavica.

[31]  A. Bhutta,et al.  Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. , 2002, JAMA.

[32]  Alan G. Sawyer,et al.  The sleeper effect in persuasion: a meta-analytic review. , 2004, Psychological bulletin.

[33]  P. Rosenbaum,et al.  Early home intervention with low-birth-weight infants and their parents. , 1986, Child development.

[34]  J. Tyson,et al.  Results at age 8 years of early intervention for low-birth-weight premature infants. The Infant Health and Development Program. , 1997, JAMA.

[35]  L. Wijnroks Early maternal stimulation and the development of cognitive competence and attention of preterm infants , 1998 .

[36]  A. Beelen,et al.  The Infant Behavioral Assessment and Intervention Program to support preterm infants after hospital discharge: a pilot study. , 2005, Developmental medicine and child neurology.

[37]  R. Rosychuk,et al.  Improvement of Short- and Long-Term Outcomes for Very Low Birth Weight Infants: Edmonton NIDCAP Trial , 2009, Pediatrics.

[38]  D. Wechsler Manual for the Wechsler preschool and primary scale of intelligence , 1967 .

[39]  T. Achenbach,et al.  Nine-year outcome of the Vermont intervention program for low birth weight infants. , 1993, Pediatrics.

[40]  K. Vandenberg,et al.  Individualized developmental care for high risk newborns in the NICU: a practice guideline. , 2007, Early human development.

[41]  B. Nurcombe,et al.  The Mother-Infant Transaction Program. The content and implications of an intervention for the mothers of low-birthweight infants. , 1990, Clinics in perinatology.

[42]  L. Doyle,et al.  Parenting Behavior Is Associated With the Early Neurobehavioral Development of Very Preterm Children , 2009, Pediatrics.

[43]  N. Bayley Bayley Scales of Infant Development , 1999 .