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Updated: Dec 28, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Effect of neonatal therapy on the motor, cognitive, and behavioral development of infants born preterm: a systematic
Sonia Khurana1, Audrey E Kane2, Shaaron E Brown3
1Motor Development Lab, Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA.
Insights
Parent-delivered motor interventions (PDMI) show promise for improving preterm infants' motor and cognitive development. Other neonatal therapies like postural control and developmental care offer short-term benefits, while oromotor interventions lack sufficient evidence.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Rehabilitation therapy
Background:
- Preterm infants face risks of developmental delays in motor, cognitive, and behavioral domains.
- Early intervention in the Neonatal Intensive Care Unit (NICU) is crucial for optimizing outcomes.
- Synthesizing evidence on various neonatal therapies is needed to guide clinical practice.
Purpose of the Study:
- To systematically review and synthesize the literature on the efficacy of neonatal therapies initiated in the NICU.
- To determine the impact of these early interventions on motor, cognitive, and behavioral outcomes in preterm infants.
Main Methods:
- Conducted a systematic search for randomized controlled trials (RCTs) and quasi-RCTs of early interventions for preterm infants (<37 weeks gestation).
- Interventions were initiated in the NICU and delivered by therapists or supported parents.
- Study quality was assessed using the Cochrane risk of bias tool, and recommendations were graded using the GRADE approach.
Main Results:
- Fifteen studies were included, categorized into parent-delivered motor intervention (PDMI), therapist-delivered postural control intervention (TDPCI), developmental care, and oromotor intervention.
- PDMI showed preliminary support for improving short- and possibly long-term motor and cognitive outcomes.
- TDPCI demonstrated effectiveness for short-term motor gains, and developmental care improved short-term behavior, though evidence for other outcomes was inconclusive.
Conclusions:
- Parent-delivered motor interventions (PDMIs) appear most effective for improving motor and cognitive outcomes in preterm infants.
- Therapist-delivered postural control interventions and developmental care offer specific short-term benefits.
- Further research is needed for oromotor interventions due to insufficient evidence.
Aim:
To synthesize the existing literature and determine the efficacy of neonatal therapy, starting in the neonatal intensive care unit (NICU), on the motor, cognitive, and behavioral outcomes of infants born preterm.
Method:
Databases were searched for randomized controlled trials or quasi-randomized controlled trials of direct therapy early intervention for infants with a gestational age of less than 37 weeks, initiated in the NICU and delivered by a therapist or parent with therapist support. Quality was evaluated using the Cochrane standardized risk of bias assessment tool. Recommendations were made using the Grading of Recommendations, Assessment, Development and Evaluations approach.
Results:
Fifteen studies met the inclusion criteria. Studies were categorized into four intervention categories: (1) parent-delivered motor intervention (PDMI); (2) therapist-delivered postural control intervention (TDPCI); (3) developmental care; and (4) oromotor intervention. Risk of bias varied from low (10 studies) to high (three studies) or was unclear (two studies).
Interpretation:
Preliminary support indicates that daily PDMI improves motor and cognitive outcomes in the short-term and possibly long-term. TDPCI is effective in promoting short-term gains in motor development. Developmental care programs designed by a neonatal therapist appear to be effective in improving short-term behavior but are inconclusive for motor and cognitive outcomes or long-term behavioral outcomes. Regarding oromotor interventions, there is insufficient research to be confident in their efficacy on improving developmental outcomes.
What This Paper Adds:
Parent-delivered motor interventions (PDMIs) are more effective in improving motor and cognitive outcomes than other interventions. Preliminary support indicates that daily PDMI improves motor and cognitive outcomes in the short- and possibly long-term. Therapist-delivered postural control interventions are effective in promoting short-term gains in motor development. Developmental care programs designed by a neonatal therapist are effective in improving the short-term behavior of infants born preterm. Oral motor interventions were found to have no effect on improving developmental outcomes.
