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Early intervention in low-birth-weight premature infants. Results through age 5 years from the Infant Health and
J Brooks-Gunn1, C M McCarton, P H Casey
1Center for Children and Families, Teachers College, Columbia University, New York, NY 10027.
Insights
Early childhood intervention improved cognitive scores for heavier low-birth-weight infants by age 5. Lighter low-birth-weight infants showed no significant cognitive, behavioral, or health differences.
Area of Science:
- Pediatrics
- Developmental Psychology
- Public Health
Background:
- Low-birth-weight (LBW) premature infants are at risk for developmental challenges.
- Early childhood interventions aim to mitigate these risks and improve long-term outcomes.
- The Infant Health and Development Program provided comprehensive support from neonatal discharge through age 3 years.
Purpose of the Study:
- To assess the long-term effects of the Infant Health and Development Program on health and development at age 5 years.
- To determine if the intervention's benefits persisted beyond early childhood.
- To evaluate differential effects based on birth weight strata.
Main Methods:
- Randomized, controlled, multicenter trial involving 985 eligible infants (birth weight ≤ 2500 g, gestational age ≤ 37 weeks).
- Infants were stratified into lighter (< or = 2000 g) and heavier (2001 to 2500 g) low-birth-weight groups.
- Intervention included home visits and center-based schooling; control group received pediatric surveillance.
Main Results:
- At age 5, heavier low-birth-weight infants in the intervention group showed significantly higher full-scale IQ (3.7 points) and verbal IQ (4.2 points) scores compared to controls.
- Lighter low-birth-weight infants in the intervention group did not exhibit significant cognitive differences at age 5.
- No significant differences in behavioral competence or health status were observed between groups, irrespective of birth weight stratum.
Conclusions:
- The early childhood intervention demonstrated lasting cognitive benefits for heavier low-birth-weight premature infants.
- The intervention's positive effects on cognitive development were specific to the heavier low-birth-weight stratum.
- No significant impact on behavioral or health outcomes was found for either low-birth-weight group at age 5.
Objective:
To evaluate the persistence of effects on health and development at age 5 years of the Infant Health and Development Program, an early childhood intervention that was provided to low-birth-weight (LBW) premature infants from neonatal discharge through age 3 years.
Design:
Randomized, controlled, multicenter trial, stratified by two LBW groups: lighter (< or = 2000 g) and heavier (2001 to 2500 g).
Setting:
Eight socioeconomically heterogeneous clinical sites.
Participants:
Of 985 eligible infants weighing 2500 g or less and at 37 weeks' or less gestational age, 377 infants were randomly assigned to the intervention group and 608 to the follow-up only group. About two thirds of the infants in each group were in the lighter LBW stratum, and one third were in the heavier LBW stratum.
Intervention:
The intervention group received home visits (from neonatal discharge through age 3 years) as well as center-based schooling (from 1 to 3 years of age). Children in both groups received pediatric surveillance.
Main Outcome Measures:
Cognitive development, behavioral competence, and health status.
Results:
At age 5 years, the intervention group had full-scale IQ scores similar to children in the follow-up only group. However, in the heavier LBW stratum, children in the intervention group had higher full-scale IQ scores (3.7 points higher; P = .03) and higher verbal IQ scores (4.2 points higher; P = .02). No significant differences between intervention and follow-up only groups in cognitive measures at age 5 years were noted in the lighter LBW infants. The intervention and follow-up groups were similar in behavior and health measures regardless of LBW stratum.
Conclusion:
The early childhood intervention provided in the first 3 years of life had effects on heavier LBW premature infants' IQ and verbal performance at age 5 years that were not observed for lighter LBW premature infants. The intervention did not affect health or behavior at age 5 years in either LBW stratum.