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Published on: January 12, 2018
The role of social risk in an early preventative care programme for infants born very preterm: a randomized
Alicia J Spittle1,2,3, Karli Treyvaud2,3,4,5, Katherine J Lee2,5
1Department of Physiotherapy, University of Melbourne, Melbourne, Australia.
Insights
Early intervention benefits preterm infants, particularly those from high social risk families, in early development. However, these cognitive gains may not persist, and parental mental health benefits are greater in lower social risk groups.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Public health
Background:
- Infants born preterm (<30 weeks gestation) face neurodevelopmental challenges.
- Family social risk can influence intervention effectiveness.
- Parental mental health is a critical factor in child development.
Purpose of the Study:
- To assess the impact of early intervention on neurodevelopment in preterm infants.
- To evaluate the effect of early intervention on parental mental health.
- To examine how family social risk modifies these intervention effects.
Main Methods:
- Randomized controlled trial comparing early intervention (n=61) with standard care (n=59) for infants <30 weeks gestation.
- Neurodevelopmental outcomes (cognitive, language, motor) assessed at 2, 4, and 8 years by blinded assessors.
- Parental anxiety and depression measured via questionnaires, analyzed with interaction terms for social risk.
Main Results:
- Significant interactions between intervention and social risk for cognitive function (2 & 4 years), motor function (4 years), and language (8 years), with greater benefits in higher social risk groups.
- Early intervention showed greater positive effects on parental depressive symptoms in lower social risk families compared to higher social risk families.
- Sustained cognitive benefits for the high-risk group were not observed at school age.
Conclusions:
- The effectiveness of early intervention for preterm infants and their caregivers is modulated by family social risk.
- Tailoring early intervention programs to account for social risk is crucial for optimizing outcomes.
- While early intervention aids high-risk families' cognitive development, parental mental health benefits are more pronounced in lower-risk families.
Aim:
To examine the differential effects of an early intervention programme for infants born preterm on neurodevelopment and parental mental health according to family social risk.
Method:
One hundred and twenty infants born earlier than 30 weeks' gestation were randomized to early intervention (n=61) or control groups (n=59). Cognitive, language, and motor outcomes were assessed by blinded assessors at 2 years, 4 years, and 8 years, and primary caregivers completed questionnaires on their anxiety and depression. Outcomes at each time point were compared between groups using linear regression with an interaction term for social risk (higher/lower).
Results:
There was evidence of interactions between intervention group and social risk for cognition at 2 years and 4 years, motor function at 4 years, and language at 8 years, with a greater intervention effect in children from higher social risk environments. In contrast, the impact of early intervention on parental depressive symptoms was greater for parents of lower social risk than for those of higher social risk.
Interpretation:
Effects of early intervention on outcomes for children born preterm and their caregivers varied according to family social risk. Family social risk should be considered when implementing early intervention programmes for children born preterm and their families.
What This Paper Adds:
Intervention is associated with better early cognitive functioning for children in higher social risk families. Positive effects of intervention for the high risk group were not sustained at school-age. Intervention has a greater effect on primary caregiver mental health in the lower social risk group compared with higher social risk.
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