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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    ABSTRACT: This study examined the effects and mediators of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with usual care in very-low-birth-weight (VLBW) preterm infants on developmental and behavioral outcomes at 24 months of age (corrected for prematurity). In this randomized controlled trial, VLBW preterm infants received either CBIP (n=57), HBIP (n=63), or usual care (n=58) from hospitalization to 12 months. At 12 months, infant emotional regulation was assessed using the toy-behind-barrier procedure and dyadic interaction was observed during free play. At 24 months, infant developmental and behavioral outcomes were assessed using the Bayley Scales of Infant and Toddler Development- 3rd edition and the Child Behavior Checklist for Ages 1.5-5, respectively. Compared with infants under usual care, the CBIP-group infants showed higher cognitive composite scores (difference, 95% confidence interval (CI)=4.4, 0.8-7.9) and a lower rate of motor delay (odds ratio (OR), 95% CI=0.29, 0.08-0.99); the HBIP-group infants had lower sleep problem scores (difference, 95% CI=-1.4, -2.5 to -0.3) and a lower rate of internalizing problems at 24 months (OR, 95% CI=0.51, 0.28-0.93) (all p<.05). The CBIP's effect on cognitive outcome was attenuated when maternal or dyadic interactive behavior was considered; whereas the HBIP's effect on sleep and internalizing behavior was attenuated when duration of orientation to a toy or object was considered. In conclusions, interventions enhanced the cognitive, motor, and behavioral outcomes of VLBW preterm infants. The effects on cognitive and behavioral outcomes might be mediated by early-improved mother-infant interaction and infant emotional regulation, respectively.
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