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A randomized controlled trial of clinic-based and home-based interventions in comparison with usual care for preterm
Ying-Chin Wu1, Chi-Hon Leng1, Wu-Shiun Hsieh2
1School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Insights
Interventions for very-low-birth-weight preterm infants improved cognitive and motor skills. Clinic-based programs boosted cognition, while home-based programs reduced sleep and behavioral issues.
Area of Science:
- Neonatal Development
- Developmental Psychology
- Pediatric Intervention
Background:
- Very-low-birth-weight (VLBW) preterm infants face risks for developmental and behavioral challenges.
- Early intervention is crucial for optimizing outcomes in this vulnerable population.
- Understanding the comparative effectiveness of different intervention settings is essential.
Purpose of the Study:
- To compare the effects of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) against usual care.
- To evaluate developmental and behavioral outcomes at 24 months corrected age in VLBW preterm infants.
- To explore potential mediators of intervention effects.
Main Methods:
- Randomized controlled trial involving VLBW preterm infants assigned to CBIP, HBIP, or usual care.
- Interventions delivered from hospitalization to 12 months corrected age.
- Assessments at 12 months (emotional regulation, dyadic interaction) and 24 months (Bayley Scales, Child Behavior Checklist).
Main Results:
- CBIP group showed higher cognitive scores and lower motor delay rates compared to usual care.
- HBIP group demonstrated lower sleep problem scores and reduced internalizing problems.
- Mediating factors included mother-infant interaction for cognitive outcomes and infant emotional regulation for behavioral outcomes.
Conclusions:
- Both CBIP and HBIP positively influenced cognitive, motor, and behavioral outcomes in VLBW preterm infants.
- Intervention effects on cognition may be mediated by mother-infant interaction.
- Intervention effects on behavior may be mediated by infant emotional regulation.
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.
