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Neurodevelopmental Outcomes at Two Years' Corrected Age of Very Preterm Infants after Implementation of a
Nienke M Halbmeijer1, Martine Jeukens-Visser2, Wes Onland1
1Department of Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Insights
The Transmural developmental support for very preterm infants and their parents (TOP) program improved cognitive function in very preterm infants by age 2. This responsive parenting intervention shows sustained positive effects on neurodevelopmental outcomes.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Neuroscience
Background:
- Very preterm (VP) infants face neurodevelopmental challenges.
- Early interventions are crucial for improving outcomes in this population.
- The Transmural developmental support for very preterm infants and their parents (TOP) program is a postdischarge responsive parenting intervention.
Purpose of the Study:
- To compare neurodevelopmental outcomes at 2 years corrected age (CA) in very preterm infants who received the TOP program versus those who did not.
- To evaluate the effect of the TOP program on cognitive and motor development, and behavior.
Main Methods:
- Retrospective analysis of data from the Systemic Hydrocortisone to Prevent Bronchopulmonary Dysplasia (SToP-BPD) study.
- Comparison of neurodevelopmental outcomes (cognitive and motor scores, behavior) at 2 years CA between VP infants who received the TOP program and those who did not.
- Statistical adjustment for baseline differences.
Main Results:
- Infants receiving the TOP program had significantly lower incidence of cognitive scores <85 (20.3% vs 35.2%) and higher mean cognitive scores (96.7 vs 92.0) at 2 years CA.
- No significant differences were observed in motor scores between the groups.
- A small but statistically significant effect was found for anxious/depressive behavior problems in the TOP group.
Conclusions:
- The TOP program demonstrates a sustained positive effect on cognitive function in very preterm infants at 2 years CA.
- Responsive parenting interventions can significantly improve neurodevelopmental outcomes in vulnerable preterm populations.
- The findings support the continued implementation and evaluation of the TOP program.
Objective:
To compare neurodevelopmental outcomes at 2 years corrected age (CA) between infants born very preterm (VP) who did or did not receive a postdischarge responsive parenting intervention (Transmural developmental support for very preterm infants and their parents [TOP program]) between discharge home and 12 months' CA.
Study Design:
The Systemic Hydrocortisone to Prevent Bronchopulmonary Dysplasia (SToP-BPD) study showed no differences between treatment groups in motor and cognitive development using the Dutch Bayley Scales of Infant Development and behavior using the Child Behavior Checklist at 2 years' CA. During its study period, the TOP program was gradually scaled up nationwide in the same population, providing an opportunity to evaluate the effect of this program on neurodevelopmental outcome, after adjusting for baseline differences.
Results:
Among 262 surviving VP infants in the SToP-BPD study, 35% received the TOP program. Infants in the TOP group had a significantly lower incidence of a cognitive score <85 (20.3% vs 35.2%; adjusted absolute risk reduction: -14.1% [95% CI: -27.2 to -1.1]; P = .03), and a significantly higher mean cognitive score (96.7 ± 13.8), compared with the non-TOP group (92.0 ± 17.5; crude mean difference: 4.7 [95% CI: 0.3 to 9.2]; P = .03). No significant differences were found on motor scores. For behavior problems, a small but statistically significant effect for anxious/depressive problems was found in the TOP group (50.5 vs 51.2; P = .02).
Conclusions:
VP infants supported by the TOP program from discharge until 12 months' CA had better cognitive function at 2 years' CA. This study demonstrates a sustained positive effect of the TOP program in VP infants.
