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Effect of early developmental intervention to improve cognitive and motor outcomes in premature infants: A systematic
Wenwen Liu1, Yu Wu2, Hui Zhou1
1Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China; Xiangya Center for Evidence-Based Practice & Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Changsha, Hunan Province, China.
Insights
Multisensory stimulation significantly improves cognitive, motor, and growth outcomes in preterm infants. This early intervention shows promise for mitigating neurodevelopmental and growth vulnerabilities in this population.
Area of Science:
- Neonatal care and developmental pediatrics.
- Evidence-based medicine and systematic reviews.
Background:
- Preterm birth poses global health challenges, increasing risks for neurodevelopmental and physical impairments.
- Current early interventions for preterm infants lack standardized protocols and consistent evidence.
Purpose of the Study:
- To systematically review and compare the efficacy of various early interventions for preterm infants.
- To rank interventions for cognitive, motor, length, and weight outcomes using network meta-analysis.
Main Methods:
- Comprehensive literature search across major databases (PubMed, Embase, CINAHL, Web of Science, Cochrane Library) up to July 2024.
- Risk-of-bias assessment using the Cochrane tool for randomized controlled trials.
- Network meta-analysis performed with Stata 18.0, ranking interventions by Surface Under the Cumulative Ranking Curve (SUCRA) and assessing evidence certainty with GRADE.
Main Results:
- 33 studies evaluated 8 early intervention methods.
- Newborn Individualized Developmental Care and Assessment Program and Mother Infant Transaction Program showed advantages in cognitive improvement.
- Multisensory stimulation demonstrated significant benefits for motor scores, length, and weight, ranking highest overall (SUCRA 74.7-100.0%).
Conclusions:
- Early interventions exhibit varied effects on preterm infant neurodevelopment and growth.
- Multisensory stimulation emerges as a highly promising intervention for enhancing cognitive, motor, and physical development in preterm infants.
Background:
Preterm birth is a global health problem associated with an increased risk of neurodevelopmental and physical growth impairment. Early interventions aim to improve cognitive, motor, length, or weight level in preterm infants, but there is wide variation in the frequency, duration, and follow-up of interventions, and the available evidence is fragmented and unsystematic.
Objective:
This study aims to compare and rank the efficacy of different early interventions for cognitive, motor, length, or weight outcomes in preterm infants using systematic review and network meta-analysis.
Methods:
PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library were systematically searched using a combination of subject terms and free words from inception to July 20, 2024. The Cochrane risk-of-bias tool for Randomized controlled trials was used to assess the quality of included studies by two trained researchers. Network meta-analysis was performed using Stata 18.0. The effects of different early interventions were estimated according to the surface under the cumulative ranking curve (SUCRA). We use the Grades of Recommendations Assessment, Development, and Evaluation (GRADE) system to perform the certainty of the evidence and strength of recommendations.
Results:
A total of 33 studies with 8 early intervention methods were included. Network meta-analysis showed that Newborn Individualized Developmental Care and Assessment Program and Mother Infant Transaction Program had more significant advantages to improve cognitive levels in preterm infants over standard nursing measures (MD = 0.81, 95% CrI: 0.22 to 1.41; MD = 0.67, 95% CrI: 0.05 to 1.30). Multisensory stimulation was higher than standard care in improving motor scores (MD = 0.95, 95% CrI: 0.16 to 1.75) and length growth (MD = 0.80, 95% CrI: 0.33 to 1.27; MD = 0.72, 95% CrI: 0.29 to 1.14), the difference was statistically significant. Moreover, Multisensory stimulation was helpful for promoting length growth in preterm infants than Newborn Individualized Developmental Care and Assessment Program (MD = 0.75, 95% CrI: 0.29 to 1.22). Based on the ranking probabilities, Multisensory stimulation was the most effective way in improving cognitive (SUCRA 74.8%), motor (SUCRA 79.3%), length (SUCRA 100.0%) and weight (SUCRA 74.7%). The certainty of evidence ranged from "high" to "very low" which was assessed by GRADE.
Conclusions:
The results show that early interventions vary in their effects on the neurodevelopment and growth development of preterm infants. Multisensory stimulation has potential benefits in mitigating neurological and growth development vulnerability in preterm infants, notably cognitive, motor and growth levels, showing promise as an effective intervention.
Prospero:
CRD42024594964.
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