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Interventions to improve neurodevelopmental outcomes of children born moderate to late preterm: a systematic review
Josephine Agyeman-Duah1, Stephen Kennedy1, Frances O'Brien2
1Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
Insights
Moderate to late preterm infants (MLPT) face higher risks of developmental impairment. This review examines early interventions for MLPT and their impact on neurodevelopmental outcomes up to age 18.
Area of Science:
- Pediatrics
- Developmental Neuroscience
- Evidence-Based Practice
Background:
- Prematurity, particularly moderate to late preterm birth (32-37 weeks gestation), is linked to significant neurodevelopmental impairments.
- Moderate to late preterm infants (MLPT) constitute 84% of preterm births and have a 2-3 times higher risk of developmental issues compared to term infants.
- Existing early interventions for preterm infants lack specific data regarding their necessity and efficacy in the MLPT population.
Purpose of the Study:
- To systematically review early childhood interventions (birth to 4 years) for MLPT children.
- To evaluate the impact of these interventions on cognitive, neurobehavioural, and motor development from birth to 18 years.
Main Methods:
- Systematic literature search across major databases (Web of Science, Medline, PsycINFO, CINAHL, EMBASE).
- Evaluation of data on MLPT children receiving developmental interventions until age 4, including parent/caregiver involvement.
- Assessment of neurodevelopmental outcomes (cognitive, neurobehavioural, motor) up to age 18.
- Methodological quality assessment using Cochrane Risk of Bias and Newcastle-Ottawa Scale; evidence quality using GRADE approach.
Main Results:
- This section is to be populated upon completion of the review and data analysis.
- Results will detail the types of interventions used and their measured effects on MLPT neurodevelopment.
- Analysis will include assessment of publication and reporting bias.
Conclusions:
- Further research and targeted early interventions are crucial for MLPT to mitigate long-term neurodevelopmental consequences.
- Prioritizing long-term follow-up and tailored interventions for MLPT is essential.
- This systematic review will provide critical data on the effectiveness of early interventions for MLPT neurodevelopment.
Abstract:
Introduction: Prematurity (birth before 37 +0 weeks' gestation) is associated with wide-ranging neurodevelopmental impairment. Prognosis among moderate to late (32 +0 to <37 +0 weeks' gestation) preterm infants (MLPT) is better compared to their counterparts born very preterm (<32 +0 weeks' gestation). However the risk of developmental impairment among MLPT, who make up about 84% of all preterm infants, is 2-3 times higher when compared to infants born at term. Early interventions have aimed to improve outcomes in preterm infants generally, but there are limited data on their need and effect in MLPT specifically. Prioritising research, long-term follow-up and early interventions targeted at ameliorating the impact of preterm birth among MLPT is required. Objectives: To conduct a systematic review of the type of early childhood interventions (from birth until 4 years of age) offered to MLPT children and to evaluate their impact on neurodevelopmental outcomes (cognitive, neurobehavioural and motor) as assessed in these children during childhood (until 18 years of age). Methods and analysis: A systematic literature search in Web of Science, Medline Ovid, PsycINFO, CINAHL and EMBASE will be conducted. Data on MLPT children receiving developmental interventions until the age of 4 years will be evaluated. Interventions may involve parents or primary caregivers. Primary outcomes are cognitive, neurobehavioural and motor development as measured from birth until the age of 18 years. The Cochrane Risk of Bias Assessment Tool will be used to evaluate the methodological quality of randomised controlled trials (RCTs) included in the review and will be graded as low, high or unclear risk of bias. The quality of non-RCTs will be evaluated with the Newcastle-Ottawa Scale. The quality of evidence for each outcome will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation Approach. Publication and reporting bias will be assessed using Egger's test and funnel plots respectively.
