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The Impact of an Interactive Guidance Intervention on Sustained Social Withdrawal in Preterm Infants in Chile:
Jorge Bustamante Loyola1,2,3, Marcela Pérez Retamal1, Andrés Mendiburo-Seguel4
1Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Insights
A behavioral guidance intervention significantly reduced sustained social withdrawal in preterm infants compared to routine care. This early assessment and intervention benefits families by lowering prevalence and potential negative developmental outcomes.
Area of Science:
- Neonatal development and behavioral science
- Pediatric psychology
- Clinical trial research
Background:
- Sustained social withdrawal is a key indicator of child emotional distress and a risk factor for psychological development.
- Preterm infants exhibit a higher probability of developing sustained social withdrawal compared to full-term infants.
- Early identification and intervention are crucial for mitigating negative developmental trajectories in preterm infants.
Observation:
- A multicenter randomized clinical trial involved 99 moderate and late preterm infants and their parents.
- Participants were randomized into an intervention group (n=49) or a control group (n=50).
- The intervention group received standardized behavioral guidance for sustained social withdrawal, alongside routine pediatric care.
Findings:
- The intervention group showed a significantly lower prevalence of sustained social withdrawal at 12 months (4.1%) compared to the control group (22.0%).
- Pooled analysis revealed a significant reduction in social withdrawal with the intervention (pooled adjusted OR = 3.57, p = 0.022).
- The intervention demonstrated a large effect size (Cohen's d = 0.70).
Implications:
- Standardized assessment and behavioral intervention for sustained social withdrawal in preterm infants are effective.
- This approach benefits families by reducing the prevalence of social withdrawal and associated negative outcomes.
- Findings support the integration of targeted behavioral guidance into routine pediatric care for preterm infants.
Background:
Sustained social withdrawal is a key indicator of child emotional distress and a risk factor for psychological development. Preterm infants have a higher probability of developing sustained social withdrawal than infants born full-term during their first year.
Objective:
To compare the effect of a behavioral guidance intervention to that of routine pediatric care on sustained social withdrawal behavior in preterm infants.
Design:
Multicenter randomized clinical trial.
Participants:
Ninety nine moderate and late preterm newborns and their parents were recruited and randomized into two groups, i.e., Intervention (n = 49) and Control (n = 50). Both groups attended medical check-ups at 2, 6 and 12 months and were assessed with the Alarm Distress Baby Scale. The intervention group received a standardized behavioral intervention if the neonatologist detected sustained social withdrawal. Also, parents filled out the Edinburgh Postnatal Depression Scale, the modified-Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale-revised.
Results:
At baseline, the prevalence of withdrawal was 4.0% (95% CI: 0.03-14.2) for the control group and 22.4% (95% CI: 13.0-35.9) for the intervention group [OR = 0.22, p = 0.028 (95% CI =0.06-0.84)]. At 6 months, the prevalence was 10.0% (95% CI: 3.9-21.8) for the control group and 6.1% (95% CI: 2.1-16.5) for the intervention group [OR = 2.09, p = 0.318 (95% CI = 0.49-8.88)]. At 12 months, the prevalence was 22.0% (95% CI: 12.8-35.2) for the control group and 4.1% (95% CI: 1.1-13.7) for the intervention group [OR = 6.63, p = 0.018 (95% CI = 1.39-31.71)]. Logistic generalized estimating equation models were performed. The pooled crude OR (considering diagnosis at 6 and 12 months) was 3.54 [p = 0.022 (95% CI = 1.20-10.44); Cohen's d= 0.70]. In the case of pooled adjusted OR, the model considered diagnosis (0 = Withdrawal, 1 = Normal) as the dependent variable, time of evaluation (1= 6 months, 2 = 12 months) and group (0 = Control, 1 = Experimental) as factors. In this case, the pooled adjusted OR was 3.57 [p = 0.022 (95% CI = 1.20-10.65); Cohen's d = 0.70].
Conclusion:
Assessment and intervention of sustained social withdrawal in preterm infants via standardized instruments benefits families by reducing its prevalence, and possible associated negative outcomes.
Clinical Trial Registration:
ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03212547, identifier: NCT03212547.
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