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Early educational intervention for very low birth weight infants: results from the Infant Health and Development
M C McCormick1, C McCarton, J Tonascia
1Department of Maternal and Child Health, Harvard School of Public Health, Boston, Massachusetts 02115.
Insights
Early educational intervention significantly improved cognitive development in very low birth weight infants. This finding supports the use of early intervention programs for improving health and developmental outcomes in high-risk newborns.
Area of Science:
- Neonatal Health
- Developmental Pediatrics
- Early Childhood Education
Background:
- Very low birth weight (VLBW) infants (< or = 1500 gm) face risks to their health and development.
- Early educational interventions may mitigate these risks.
- Previous studies showed benefits in heavier infants.
Purpose of the Study:
- To assess the impact of early educational intervention on the health and development of VLBW infants.
- To determine if benefits observed in heavier infants extend to VLBW infants.
- To evaluate cognitive, behavioral, and health status outcomes.
Main Methods:
- Randomized controlled trial involving 280 VLBW infants across eight diverse sites.
- Intervention group received home visits and center-based education until 36 months corrected age.
- Control group received follow-up care only.
Main Results:
- Cognitive development scores were significantly higher in the intervention group (7.2 points increase, p=0.002).
- This cognitive advantage increased to 9.4 points after excluding infants with cerebral palsy.
- No significant differences were found in behavioral competence, serious morbidity, or functional health status overall.
Conclusions:
- The cognitive benefits of early educational intervention extend to VLBW infants.
- These findings support the implementation of early intervention programs for VLBW infants.
- While cognitive gains are evident, further research may explore other developmental domains.
Objective:
To examine the effect of early educational intervention after discharge from the hospital on the health and developmental status of very low birth weight (< or = 1500 gm) infants.
Design:
Randomized, controlled trial, with post hoc analysis.
Setting:
Eight sites, heterogeneous for sociodemographic and health care use.
Participants:
Infants (N = 280) born weighing < or = 1500 gm and selected for the Infant Health and Development Program. Eligibility was limited primarily by geographic distance from the day care center. One third were randomly assigned to the intervention (INT) group and two thirds to follow-up only.
Interventions:
All children received intensive pediatric and developmental surveillance. The INT group received home visits and center-based educational interventions until 36 months of age (corrected for gestational age when final assessments were completed).
Outcomes:
Cognitive development (Stanford-Binet Intelligence Scale), behavioral competence (Achebach Child Behavior Checklist), and health status (indexes summarizing reported morbidity, the Functional Status II (R) Scale, and General Health Ratings Index).
Results:
Cognitive development scores were 7.2 points higher (p = 0.002) in the INT group, after adjustment for baseline differences in site, sociodemographic characteristics, and neonatal morbidity, and were 9.4 points higher (p < 0.0003) when the 29 children with significant cerebral palsy were removed. No differences in behavior, serious morbidity, functional status, or health rating were found overall. The infants in the INT group who weighted < or = 1000 gm at birth had significantly lower behavior problem scores but no differences on other outcomes. All children in the INT group had slightly higher rates of less serious morbidity.
Conclusion:
The advantage conferred by being in the INT group, as previously reported for heavier infants, extends to very low birth weight children, supporting the use of early intervention in this group.