Long-term Benefits of Home-based Preventive Care for Preterm Infants: A Randomized Trial

Critical Care and Neurosciences, Murdoch Childrens Research Institute, Victoria, Australia
PEDIATRICS (Impact Factor: 5.47). 11/2012; 130(6). DOI: 10.1542/peds.2012-0426
Source: PubMed


We have previously reported improved caregiver mental health and infant behavior at 2 years following a home-based preventive care program for very preterm infants and their caregivers. This study aimed to determine the longer-term effectiveness of the program by reviewing caregivers and children at preschool age.

One hundred twenty very preterm infants (<30 weeks' gestation) were randomly allocated to intervention (n = 61) or control (n = 59) groups. The intervention included 9 home visits over the first year of life targeting infant development, parent mental health, and the parent-infant relationship. The control group received standard care. At 4 years' corrected age, child cognitive, behavioral, and motor functioning and caregiver mental health were assessed.

At age 4 years, 105 (89%) children were reviewed. There was little evidence of differences in cognitive or motor functioning between groups. The intervention group had lower scores for child internalizing behaviors than the control group (mean difference -5.3, 95% confidence interval [CI] -9.6 to -0.9, P = .02). Caregivers in the intervention group had fewer anxiety symptoms (mean difference -1.8, 95% CI -3.3 to -0.4, P = .01) and were less likely to exhibit "at-risk" anxiety (odds ratio 0.3, 95% CI 0.1 to 0.7, P = .01) than those in the control group.

This home-based preventive care program for very preterm infants has selective long-term benefits, including less caregiver anxiety and reduced preschooler internalizing behaviors.

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    • "Preterm births with very-low-birth-weight (VLBW; birth weight < 1500 g) exert unfavorable effects on not only maternal psychological wellness (Saigal & Doyle, 2008) and mother–infant interaction (Bozzette, 2007) but also child developmental outcomes (Aarnoudse-Moens, Weisglas-Kuperus, van Goudoever, & Oosterlaan, 2009; Saigal & Doyle, 2008). In Western countries, various interventions have been developed for preterm infants that yielded small motor benefits in early infancy and moderate cognitive benefits from infancy to preschool age (Orton, Spittle, Doyle, Anderson, & Boyd, 2009; Spittle, Orton, Anderson, Boyd, & Doyle, 2012; Vanderveen, Bassler, Robertson, & Kirpalani, 2009), but inconclusive effects on behavioral outcome (Blair, 2002; Brooks-Gunn, Klebanov, Liaw, & Spiker, 1993; Kaaresen et al., 2008; Kleberg, Westrup, & Stjernqvist, 2000; Koldewijn et al., 2010, 2005, 2009; Nordhov, Ronning, Ulvund, Dahl, & Kaaresen, 2012; Spencer-Smith et al., 2012; Spittle et al., 2010; Westrup, Bohm, Lagercrantz, & Stjernqvist, 2004). The investigation in Eastern societies has been limited to only one study in China, which showed cognitive benefits (Bao, Sun, Wei, & Coo, 1999). "
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