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A multifaceted intervention for infants with failure to thrive. A prospective study
P H Casey1, K J Kelleher, R H Bradley
1Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock.
Insights
This study found that a multifaceted intervention did not reduce failure to thrive (FTT) in preterm infants. However, higher compliance with the intervention was linked to improved 3-year IQ and behavior in children with FTT.
Area of Science:
- Pediatrics
- Developmental Psychology
- Public Health
Background:
- Failure to thrive (FTT) is a significant concern in preterm infants with low birth weights.
- Early interventions aim to improve developmental outcomes in this vulnerable population.
Purpose of the Study:
- To evaluate a multifaceted intervention's impact on FTT incidence and 3-year developmental outcomes (intelligence, health, growth, behavior) in preterm infants.
- To assess if the intervention improved outcomes for children who developed FTT.
Main Methods:
- A 3-year prospective, randomized clinical trial involving 914 preterm infants with low birth weights across 8 US university hospitals.
- Intervention included weekly/biweekly home visits for family support and curricula, plus a 5-day/week child development center program until age 3.
- Outcomes measured included FTT incidence, 3-year intelligence (IQ), health, growth, and behavior status.
Main Results:
- The intervention did not significantly decrease the incidence of FTT (20% vs. 22% in control).
- No overall differences in 3-year outcomes were observed between treatment and control groups for children with FTT.
- However, treatment group assignment predicted higher 36-month IQ (P=.005) after controlling for other factors.
- Higher compliance with the intervention correlated with better 3-year IQ and behavior scores in children with FTT.
Conclusions:
- The multifaceted intervention did not alter FTT incidence or overall 3-year outcomes in this cohort.
- Significant positive effects on 3-year IQ were observed after controlling for covariates.
- The beneficial impact on IQ was most pronounced in families with higher adherence to the intervention program.
Objective:
To determine whether a multifaceted intervention decreased the incidence of failure to thrive (FTT) in a group of preterm infants with low birth weights and improved the 3-year intelligence, health, growth, and behavior status of the children with FTT.
Design:
Three-year, prospective, randomized, clinical trial.
Setting:
Eight large university hospital sites throughout the United States.
Sample:
Nine hundred fourteen preterm infants with low birth weights who were born at the sites and met study criteria.
Intervention:
Home visits weekly during the first year of life and biweekly thereafter until the age of 3 years to provide family support and implement two curricula; and attendance at a child development center from 12 months until 3 years of age, 5 days a week, to deliver an early childhood educational intervention.
Results:
The incidence of FTT did not differ between the treatment and control groups (20% vs 22%). Overall, children with FTT in the treatment group were not different from children with FTT in the follow-up group on any of the outcome variables. However, after controlling for other factors, treatment group membership significantly contributed to the prediction model of 36-month IQ (P = .005) for the children with FTT. In addition, children with FTT in the intervention group with higher compliance demonstrated higher 3-year IQ and better behavior scores than the children with FTT in the low-compliance group.
Conclusions:
The intervention did not change the incidence of FTT or the 3-year outcomes in this low-birth-weight, preterm cohort. After controlling for multiple independent variables, marked effects on 3-year IQ were noted. In addition, these beneficial effects were most pronounced in families that were most complaint with the intervention.