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Results at age 8 years of early intervention for low-birth-weight premature infants. The Infant Health and
C M McCarton1, J Brooks-Gunn, I F Wallace
1Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Insights
Early intervention for heavier low-birthweight (LBW) premature infants showed lasting benefits in cognitive and academic skills by age 8 years. Lighter LBW infants did not show sustained advantages, highlighting the need for new strategies.
Area of Science:
- Pediatrics
- Developmental Psychology
- Public Health
Background:
- Premature infants, particularly those with low birth weight (LBW), face developmental challenges.
- Early intervention programs aim to mitigate these challenges and improve long-term outcomes.
- Previous studies have shown benefits of early intervention for LBW infants, but long-term effects require further investigation.
Purpose of the Study:
- To reevaluate children at age 8 years who participated in an early intervention randomized clinical trial during their first three years of life.
- To assess the sustained impact of early services on cognitive functioning, academic achievement, and behavioral outcomes in low-birthweight (LBW) premature infants.
- To determine if intervention effects differ between lighter (<=2000g) and heavier (2001-2500g) LBW infants.
Main Methods:
- Follow-up of a randomized controlled trial involving premature infants (<=37 weeks' gestation) stratified by LBW.
- Intervention group received home visits, child development center services, and parent group meetings from birth to 3 years.
- At age 8 years, 874 children were assessed using cognitive scales (WISC-III, PPVT-R), academic achievement tests (Woodcock-Johnson-R), and parental reports (CBCL, CHGS).
Main Results:
- No significant differences were observed between intervention and follow-up only groups in the entire cohort or the lighter LBW stratum at age 8 years.
- Heavier LBW infants in the intervention group showed significant advantages in full-scale IQ (4.4 points higher), verbal IQ (4.2 points higher), performance IQ (3.9 points higher), mathematics achievement (4.8 points higher), and receptive vocabulary (6.7 points higher).
- The overall intervention group received less favorable ratings on a physical functioning subscale, and lighter LBW intervention group mothers reported more social limitations due to behavior.
Conclusions:
- Early intervention demonstrated modest, sustained benefits in cognitive and academic skills for heavier LBW premature children at age 8 years.
- The significant positive effects observed at 3 years attenuated in both heavier and lighter LBW groups by age 8 years.
- There is a critical need to develop and implement novel intervention strategies to ensure lasting benefits for low-birthweight premature infants.
Objective:
To reevaluate at age 8 years children who had participated during the first 3 years of life in a randomized clinical trial of special services for low-birthweight (LBW) premature infants.
Design:
Follow-up of a randomized controlled trial of premature infants (< or = 37 weeks' gestation), stratified by 2 LBW groups (lighter [< or = 2000 g] and heavier [2001-2500 g]) and divided into intervention (n=377) and follow-up only (n=608) groups.
Setting:
Eight sites serving diverse populations.
Participants:
At age 8 years, 874 children were assessed: 336 in the intervention group and 538 in the follow-up only group.
Intervention:
The 3-year intervention consisted of home visits (birth to 3 years), child development center services (ages 1 to 3 years), and parent group meetings (ages 1 to 3 years).
Primary Outcome Measures:
Cognitive functioning (Weschler Intelligence Scale for Children-III; Peabody Picture Vocabulary Test-Revised); academic achievement (Woodcock-Johnson Tests of Achievement-Revised); and parental reports of school performance, behavior (Child Behavior Checklist), and health (Child General Health Survey).
Results:
At age 8 years, in the entire cohort and in the lighter LBW stratum, the intervention and follow-up only groups were similar on all primary outcome measures. Differences favoring the intervention group were found within the heavier LBW group: full-scale IQ score (4.4 points higher, P=.007), verbal IQ score (4.2 points higher, P=.01), performance IQ score (3.9 points higher, P=.02), mathematics achievement score (4.8 points higher, P=.04), and receptive vocabulary score (6.7 points higher, P=.001). On a physical functioning subscale, the whole intervention group received less favorable ratings, while the lighter LBW intervention group had lower maternal ratings assessing social limitations caused by behavior.
Conclusion:
Although at age 8 years there were modest intervention-related differences in the cognitive and academic skills of heavier LBW premature children, attenuation of the large favorable effects seen at 3 years was observed in both the heavier and lighter LBW groups. This indicates a need to develop additional intervention strategies for LBW premature children that can provide sustained benefits.