1
|
Reynolds K, Urbanowicz A, Mayston M, Foley S. Kids+ Parent Infant Program (PIP): a community model for supporting partnerships in early developmental follow-up and support. Front Pediatr 2024; 12:1354971. [PMID: 38756970 PMCID: PMC11096506 DOI: 10.3389/fped.2024.1354971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/19/2024] [Indexed: 05/18/2024] Open
Abstract
High-risk infants are discharged home from hospital with increased care needs and the potential for the emergence of developmental disabilities, contributing to high levels of parental stress and anxiety. To enable optimal outcomes for high-risk infants and their families, developmental follow-up programs need to continue following hospital discharge. However, current follow-up care for high-risk infants is variable in terms of type, access and equity, and there seems to be a gap in existing services such as supporting the transition home, parental support, and inclusion of all at-risk infants regardless of causality. Routine follow-up that identifies developmental delays or neuromotor concerns can facilitate timely referral and access to targeted intervention during critical periods of development. The Kids+ Parent Infant Program (PIP) is a unique model of developmental follow-up that shares some characteristics with established programs, but also includes additional key elements for a seamless, wrap-around service for all high-risk infants and their families living in a regional area of Australia. This community-based program provides integrated assessment and intervention of infants, alongside parent support and education, embracing a holistic model that accounts for the complexity and interrelatedness of infant, parent, medical and developmental factors. By prioritising the well-being of high-risk infants and their families, the Kids+ PIP paves the way for improved developmental outcomes and provides an innovative model for developmental follow-up, with the potential for reproduction in other healthcare settings.
Collapse
Affiliation(s)
- K. Reynolds
- Kids Plus Foundation (Kids+), Geelong, VIC, Australia
- Childrens Therapy Services, Geelong, VIC, Australia
| | - A. Urbanowicz
- Kids Plus Foundation (Kids+), Geelong, VIC, Australia
- Australian Institute for Health Transformation, Determinants of Health, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - M. Mayston
- Division of Biosciences, Neurosciences, Physiology & Pharmacology, University College London, London, United Kingdom
| | - S. Foley
- Kids Plus Foundation (Kids+), Geelong, VIC, Australia
| |
Collapse
|
2
|
Orton J, Doyle LW, Tripathi T, Boyd R, Anderson PJ, Spittle A. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2024; 2:CD005495. [PMID: 38348930 PMCID: PMC10862558 DOI: 10.1002/14651858.cd005495.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Infants born preterm are at increased risk of cognitive and motor impairments compared with infants born at term. Early developmental interventions for preterm infants are targeted at the infant or the parent-infant relationship, or both, and may focus on different aspects of early development. They aim to improve developmental outcomes for these infants, but the long-term benefits remain unclear. This is an update of a Cochrane review first published in 2007 and updated in 2012 and 2015. OBJECTIVES Primary objective To assess the effect of early developmental interventions compared with standard care in prevention of motor or cognitive impairment for preterm infants in infancy (zero to < three years), preschool age (three to < five years), and school age (five to < 18 years). Secondary objective To assess the effect of early developmental interventions compared with standard care on motor or cognitive impairment for subgroups of preterm infants, including groups based on gestational age, birthweight, brain injury, timing or focus of intervention and study quality. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and trial registries in July 2023. We cross-referenced relevant literature, including identified trials and existing review articles. SELECTION CRITERIA Studies included randomised, quasi-randomised controlled trials (RCTs) or cluster-randomised trials of early developmental intervention programmes that began within the first 12 months of life for infants born before 37 weeks' gestational age (GA). Interventions could commence as an inpatient but had to include a post discharge component for inclusion in this review. Outcome measures were not prespecified, other than that they had to assess cognitive outcomes, motor outcomes or both. The control groups in the studies could receive standard care that would normally be provided. DATA COLLECTION AND ANALYSIS Data were extracted from the included studies regarding study and participant characteristics, timing and focus of interventions and cognitive and motor outcomes. Meta-analysis using RevMan was carried out to determine the effects of early developmental interventions at each age range: infancy (zero to < three years), preschool age (three to < five years) and school age (five to < 18 years) on cognitive and motor outcomes. Subgroup analyses focused on GA, birthweight, brain injury, time of commencement of the intervention, focus of the intervention and study quality. We used standard methodological procedures expected by Cochrane to collect data and evaluate bias. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS Forty-four studies met the inclusion criteria (5051 randomly assigned participants). There were 19 new studies identified in this update (600 participants) and a further 17 studies awaiting outcomes. Three previously included studies had new data. There was variability in the focus and intensity of the interventions, participant characteristics, and length of follow-up. All included studies were either single or multicentre trials and the number of participants varied from fewer than 20 to up to 915 in one study. The trials included in this review were mainly undertaken in middle- or high-income countries. The majority of studies commenced in the hospital, with fewer commencing once the infant was home. The focus of the intervention programmes for new included studies was increasingly targeted at both the infant and the parent-infant relationship. The intensity and dosages of interventions varied between studies, which is important when considering the applicability of any programme in a clinical setting. Meta-analysis demonstrated that early developmental intervention may improve cognitive outcomes in infancy (developmental quotient (DQ): standardised mean difference (SMD) 0.27 standard deviations (SDs), 95% confidence interval (CI) 0.15 to 0.40; P < 0.001; 25 studies; 3132 participants, low-certainty evidence), and improves cognitive outcomes at preschool age (intelligence quotient (IQ); SMD 0.39 SD, 95% CI 0.29 to 0.50; P < 0.001; 9 studies; 1524 participants, high-certainty evidence). However, early developmental intervention may not improve cognitive outcomes at school age (IQ: SMD 0.16 SD, 95% CI -0.06 to 0.38; P = 0.15; 6 studies; 1453 participants, low-certainty evidence). Heterogeneity between studies for cognitive outcomes in infancy and preschool age was moderate and at school age was substantial. Regarding motor function, meta-analysis of 23 studies showed that early developmental interventions may improve motor outcomes in infancy (motor scale DQ: SMD 0.12 SD, 95% CI 0.04 to 0.19; P = 0.003; 23 studies; 2737 participants, low-certainty evidence). At preschool age, the intervention probably did not improve motor outcomes (motor scale: SMD 0.08 SD, 95% CI -0.16 to 0.32; P = 0.53; 3 studies; 264 participants, moderate-certainty evidence). The evidence at school age for both continuous (motor scale: SMD -0.06 SD, 95% CI -0.31 to 0.18; P = 0.61; three studies; 265 participants, low-certainty evidence) and dichotomous outcome measures (low score on Movement Assessment Battery for Children (ABC) : RR 1.04, 95% CI 0.82 to 1.32; P = 0.74; 3 studies; 413 participants, low-certainty evidence) suggests that intervention may not improve motor outcome. The main source of bias was performance bias, where there was a lack of blinding of participants and personnel, which was unavoidable in this type of intervention study. Other biases in some studies included attrition bias where the outcome data were incomplete, and inadequate allocation concealment or selection bias. The GRADE assessment identified a lower certainty of evidence in the cognitive and motor outcomes at school age. Cognitive outcomes at preschool age demonstrated a high certainty due to more consistency and a larger treatment effect. AUTHORS' CONCLUSIONS Early developmental intervention programmes for preterm infants probably improve cognitive and motor outcomes during infancy (low-certainty evidence) while, at preschool age, intervention is shown to improve cognitive outcomes (high-certainty evidence). Considerable heterogeneity exists between studies due to variations in aspects of the intervention programmes, the population and outcome measures utilised. Further research is needed to determine which types of early developmental interventions are most effective in improving cognitive and motor outcomes, and in particular to discern whether there is a longer-term benefit from these programmes.
Collapse
Affiliation(s)
- Jane Orton
- Royal Women's Hospital, Parkville, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
| | - Lex W Doyle
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Tanya Tripathi
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
| | - Roslyn Boyd
- The University of Queensland, Brisbane, Australia
| | - Peter J Anderson
- Department of Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Alicia Spittle
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute and the University of Melbourne, Parkville, Australia
| |
Collapse
|
3
|
Sandoval-Cuellar C, Castellanos-Garrido AL, Ospina Romero AM, Boude Figueredo ÓR, Serrano-Gómez ME, Fuya Caro CA, Molina Cárdenas DC, Pinto Rosas EM. Motor development in premature infants: Study protocol for an interdisciplinary hospital-home intervention. Pediatr Neonatol 2023; 64:577-584. [PMID: 37002053 DOI: 10.1016/j.pedneo.2022.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/01/2022] [Accepted: 12/08/2022] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Deviations occur in the neuropsychomotor development of premature infants; early interventions minimize delay motor. This study aimed to determine the effect of an interdisciplinary hospital-home intervention addressing motor development adaptation in premature infants in Colombia in comparison with traditional interventions. METHODS This study was based on a parallel design, with two groups, namely, experimental and control. The experimental group, hospital-home intervention (HHI) performed in two settings (i.e., hospital neonatal care units and homes), and the control group, traditional intervention, (TI) performed in institutions for premature infants. The sample will be composed of 130 randomly-allocated infants, 65 in the experimental group (HHI) and 65 in the control group (TI) of moderate to late preterm infants (gestational age between 34 and 37 weeks), weighing more than or equal to 1.800 g, who are hemodynamically stable and reside in the cities of Tunja and Bogotá-Colombia recruited between 2021 and 2022. For the pre- and post-intervention assessments, the TIMPSI and the CapDMP are the instruments used to assess motor development and the degree of parents' or caregivers' knowledge about motor development. The HHI is composed of 10 intervention strategies based on stimulation of motor development, performed twice a day for 10 min for two months, in combination with calls to a mobile device, using software (Baby Motor Skills) and an instant messaging system (WhatsApp). RESULTS This hospital-home intervention program proposes an approach focused on the motor development of premature infants, based on sensory and motor stimulation strategies, in addition to follow-up performed at home with the use of a mobile application that improves the motor development of premature infants. Register Clinical Trial: NCT04563364. CONCLUSION The HHI provides the opportunity to determine whether the individualized four-week from admission to follow up at home with parent training will improve the motor skills of premature infants.
Collapse
|
4
|
Synnes A, Luu TM, Afifi J, Khairy M, de Cabo C, Moddemann D, Hendson L, Reichert A, Coughlin K, Nguyen KA, Richter LL, Bacchini F, Aziz K. Parent-Integrated Interventions to Improve Language Development in Children Born Very Preterm. CHILDREN (BASEL, SWITZERLAND) 2023; 10:953. [PMID: 37371185 DOI: 10.3390/children10060953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023]
Abstract
Neurodevelopmental challenges in children born very preterm are common and not improving. This study tested the feasibility of using Evidence-based Practice to Improve Quality (EPIQ), a proven quality improvement technique that incorporates scientific evidence to target improving language abilities in very preterm populations in 10 Canadian neonatal follow-up programs. Feasibility was defined as at least 70% of sites completing four intervention cycles and 75% of cycles meeting targeted aims. Systematic reviews were reviewed and performed, an online quality improvement educational tool was developed, multidisciplinary teams that included parents were created and trained, and sites provided virtual support to implement and audit locally at least four intervention cycles of approximately 6 months in duration. Eight of ten sites implemented at least four intervention cycles. Of the 48 cycles completed, audits showed 41 (85%) met their aim. Though COVID-19 was a barrier, parent involvement, champions, and institutional support facilitated success. EPIQ is a feasible quality improvement methodology to implement family-integrated evidence-informed interventions to support language interventions in neonatal follow-up programs. Further studies are required to identify potential benefits of service outcomes, patients, and families and to evaluate sustainability.
Collapse
Affiliation(s)
- Anne Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Women's Hospital and Health Centre, Vancouver, BC V5Z 4H4, Canada
- BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Thuy Mai Luu
- Department of Pediatrics and Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Division of Neonatal Perinatal Medicine, IWK Health Centre, Halifax, NS B3K 6R8, Canada
| | - May Khairy
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Cecilia de Cabo
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Diane Moddemann
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Leonora Hendson
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Amber Reichert
- Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada
| | - Kevin Coughlin
- Children's Hospital at London Health Sciences Centre, London, ON N6A 5W9, Canada
| | | | - Lindsay L Richter
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Fabiana Bacchini
- Canadian Premature Babies Foundation, Etobicoke, ON M8X 1Y3, Canada
| | - Khalid Aziz
- The Office of Lifelong Learning, University of Alberta, Edmonton, AB T6G 1C9, Canada
| |
Collapse
|
5
|
Abstract
OBJECTIVES Children born very preterm (VP) are susceptible to a range of cognitive impairments, yet the effects of VP birth on long-term, episodic, and prospective memory remains unclear. This study examined episodic and prospective memory functioning in children born VP compared with their term-born counterparts at 13 years. METHOD VP (n = 81: born <30 weeks' gestation) and term (n = 26) groups were aged between 12 and 14 years. Children completed: (i) standardized verbal and visuospatial episodic memory tests; and (ii) an experimental time- and event-based prospective memory test that included short-term (within assessment session) and long-term (up to 1-week post-session) tasks. Parents completed a questionnaire assessing memory functions in everyday life. RESULTS The VP group performed worse on all measures of verbal and visuospatial episodic memory than the term group. While there were no group differences in event-based or long-term prospective memory, the VP group performed worse on time-based and short-term prospective memory tasks than term-born counterparts. Parents of children born VP reported more everyday memory difficulties than parents of children born at term, with parent-ratings indicating significantly elevated rates of everyday memory challenges in children born VP. CONCLUSIONS Children born VP warrant long-term surveillance, as challenges associated with VP birth include memory difficulties at 13 years. This study highlights the need for greater research and clinical attention into childhood functional memory outcomes.
Collapse
|
6
|
Griffith T, Singh A, Naber M, Hummel P, Bartholomew C, Amin S, White-Traut R, Garfield L. Scoping review of interventions to support families with preterm infants post-NICU discharge. J Pediatr Nurs 2022; 67:e135-e149. [PMID: 36041959 PMCID: PMC9729411 DOI: 10.1016/j.pedn.2022.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND A successful transition from the NICU to home is fundamental for the long-term health and well-being of preterm infants. Post-NICU discharge, parents may experience a lack of support and resources during the transition to home. The purpose of this scoping review was to identify post-NICU discharge interventions that may reduce parental stress and provide support to families with preterm infants. METHOD Systematic searches of databases, i.e., PubMed, Web of Science, and CINAHL. Inclusion criteria were data-based articles: 1) published in English between 2011 and 2021, 2) published in peer-reviewed journals, (3) focused on families with preterm infants, and (4) focused on interventions to reduce parental stress and provide support to families with preterm infants post-NICU discharge. RESULTS 26 articles were included and synthesized. We identified the following face-to-face and remote communication interventions: in-person home visits, phone/video calls, text messages, periodic email questionnaires, mobile/website apps, and online social networking sites. DISCUSSION Families may highly benefit from a comprehensive family-focused post-NICU discharge follow-up intervention that includes face-to-face and remote communication and support. Post-NICU discharge interventions are imperative to provide education related to infant care and health, increase parental confidence and competency, increase parent-infant relationship, promote emotional and social support, reduce unplanned hospital visits, parental stress, and maternal post-partum depression.
Collapse
Affiliation(s)
- Thao Griffith
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA.
| | - Anamika Singh
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Margaret Naber
- Division of Neonatology, Loyola University Medical Center, Maywood, IL, USA
| | - Patricia Hummel
- Division of Neonatology, Loyola University Medical Center, Maywood, IL, USA
| | | | - Sachin Amin
- Division of Neonatology, Loyola University Medical Center, Maywood, IL, USA
| | - Rosemary White-Traut
- Nursing Research, Children's Wisconsin, Milwaukee, WI, United States of America; Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Lindsey Garfield
- Department of Family and Community Health Nursing, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| |
Collapse
|
7
|
Treyvaud K, Eeles AL, Spittle AJ, Lee KJ, Cheong JLY, Shah P, Doyle LW, Anderson PJ. Preterm Infant Outcomes at 24 Months After Clinician-Supported Web-Based Intervention. Pediatrics 2022; 150:189551. [PMID: 36130917 DOI: 10.1542/peds.2021-055398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED The authors of this study evaluated infant and parent outcomes at 12 and 24 months after a clinician-supported, web-based early intervention for preterm infants. OBJECTIVE To examine the efficacy of a clinician-supported, web-based intervention delivered over the first year after birth compared with standard care in children born after <34 weeks' gestation, on child development at 24 months corrected age (CA), parental mental health, and the parent-child relationship at 24 months. METHODS We randomly allocated 103 preterm infants to clinician-supported, web-based intervention (n = 50) or standard care control (n = 53) groups. At 24 months CA, child cognitive, language, motor, social-emotional development, and the parent-child relationship were assessed. Parental mental health and quality of life were assessed at 12 and 24 months CA. RESULTS At 24 months, child development, maternal mental health, and maternal quality of life were similar for the intervention and control groups. There was some evidence that mothers in the intervention group had lower odds of being in the elevated category for depression at 12 months (odds ratio: 0.19; 95% confidence interval [CI]: 0.04-0.90; P = .04). Scores were higher in the intervention group for child responsiveness (mean difference: 0.57; 95% CI: 0.03-1.11; P = .04), child involvement (mean difference: 0.61; 95% CI: 0.09-1.13; P = .02), and maternal structuring (mean difference: 0.72; 95% CI: 0.22-1.21; P = .01) during the parent-infant interaction at 24 months. CONCLUSIONS This study provides preliminary evidence that a clinician-supported, web-based early intervention program for preterm infants had a positive effect on the parent-child relationship and maternal mental health immediately after the intervention but potentially little effect on child development.
Collapse
Affiliation(s)
- Karli Treyvaud
- La Trobe University, Victoria, Australia.,Murdoch Children's Research Institute, Victoria, Australia.,University of Melbourne, Victoria, Australia.,Royal Women's Hospital, Victoria, Australia
| | - Abbey L Eeles
- Murdoch Children's Research Institute, Victoria, Australia.,University of Melbourne, Victoria, Australia.,Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Victoria, Australia.,University of Melbourne, Victoria, Australia.,Royal Women's Hospital, Victoria, Australia
| | - Katherine J Lee
- Murdoch Children's Research Institute, Victoria, Australia.,University of Melbourne, Victoria, Australia
| | - Jeanie L Y Cheong
- Murdoch Children's Research Institute, Victoria, Australia.,University of Melbourne, Victoria, Australia.,Royal Women's Hospital, Victoria, Australia
| | - Parool Shah
- Life's Little Treasures Foundation, Ringwood, VIC, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Victoria, Australia.,University of Melbourne, Victoria, Australia.,Royal Women's Hospital, Victoria, Australia
| | - Peter J Anderson
- Murdoch Children's Research Institute, Victoria, Australia.,Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| |
Collapse
|
8
|
Stedall PM, Spencer-Smith MM, Mainzer RM, Treyvaud K, Burnett AC, Doyle LW, Spittle AJ, Anderson PJ. Thirteen-Year Outcomes of a Randomized Clinical Trial of Early Preventive Care for Very Preterm Infants and Their Parents. J Pediatr 2022; 246:80-88.e4. [PMID: 35304169 DOI: 10.1016/j.jpeds.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate 13-year outcomes of a randomized controlled trial of preventive care (VIBeS Plus) for infants born very preterm and their parents and examine whether possible effects of intervention varied by family social risk. STUDY DESIGN Families were randomized to an intervention arm (n = 61) or a standard care arm (n = 59). The intervention was delivered at home by psychologists and physiotherapists over the infants' first year, focusing on infant development and parental mental health. At 13 years corrected age, cognitive, motor, and behavioral outcomes, and parental mental health were assessed. Primary estimands were between-group mean differences, estimated using multiple imputed regression models. RESULTS Follow-up included 81 surviving children (69%). There was little evidence of benefits of the intervention for IQ, attention, executive functioning, working memory, and academic skills regardless of level of social risk. Specifically, mean differences in adolescent cognitive outcomes ranged from -2.0 units (95% CI, -9.9 to 5.9) in favor of standard treatment to 5.1 units (95% CI, -2.3 to 12.5) favoring the intervention. A group-by-social risk interaction was observed only for adolescent motor outcomes, with mean differences favoring the intervention for those at higher social risk (balance, 4.9; 95% CI, 1.3-8.5; total motor, 3.2; 95% CI, 0.3-6.2), but not those at lower social risk (balance, -0.3; 95% CI, -2.4 to 1.9; total motor, 0.03; 95% CI, -1.9 to 2.0). Mean differences in adolescent behavior and parental mental health ranged from -6.6 (95% CI -13.8, 0.5) to -0.2 (95% CI, -1.9 to 1.4) and -1.8 (95% CI, -4.1 to 0.6) to -1.7 (95% CI, -4.3 to 1.0), respectively, indicating a pattern of fewer symptoms in the intervention group. CONCLUSIONS Benefits of the intervention persisted for adolescent behavior, with better motor outcomes observed in those from socially disadvantaged families. Replication with larger samples, multiple informant reports, and assessment of quality of life-related outcomes is warranted. TRIAL REGISTRATION http://www.anzctr.org.au/: ACTRN12605000492651.
Collapse
Affiliation(s)
- Paulina M Stedall
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Megan M Spencer-Smith
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Rheanna M Mainzer
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Karli Treyvaud
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Alice C Burnett
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Premature Infant Follow-up Program, Royal Women's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neonatal Medicine, Royal Children's Hospital, Parkville, Australia
| | - Lex W Doyle
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Premature Infant Follow-up Program, Royal Women's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
| | - Alicia J Spittle
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Parkville, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| |
Collapse
|
9
|
Olsen JE, Lee KJ, Spittle AJ, Anderson PJ, Doyle LW, Cheong JLY. The causal effect of being born extremely preterm or extremely low birthweight on neurodevelopment and social-emotional development at 2 years. Acta Paediatr 2022; 111:107-114. [PMID: 34494301 DOI: 10.1111/apa.16098] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/22/2022]
Abstract
AIM To assess the causal effect of being born extremely preterm (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g), compared with being born at term, on neurodevelopment and social-emotional development at 2 years' corrected age. METHODS Prospective geographical cohort study of children born EP/ELBW over 12 months in 2016 from Victoria, Australia, and term-born controls. Children were assessed at 2 years' corrected age with the Bayley Scales of Infant and Toddler Development-3rd edition and the Infant-Toddler Social and Emotional Assessment. Delay was defined as <-1 standard deviation relative to the mean of controls. The estimand of interest was the mean difference/odds ratio (OR) between the EP/ELBW and control groups estimated using linear/logistic regression, adjusted for multiple pregnancy and social risk. RESULTS A total of 205 EP/ELBW and 201 controls were assessed at 2 years. Delay/concerns were more common in the EP/ELBW group compared with controls, for cognitive (OR 3.7 [95% confidence interval 2.3, 6.0]), language (5.3 [3.1, 9.0]) and motor (3.9 [2.3, 6.3]) development, and social-emotional competence (4.1 [1.6, 10.2]). CONCLUSION Being born EP/ELBW has an adverse effect on cognitive, language and motor development, and social-emotional competence at 2 years' corrected age. Close developmental surveillance, including social-emotional development, is recommended.
Collapse
Affiliation(s)
- Joy E. Olsen
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
| | - Katherine J. Lee
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
| | - Alicia J. Spittle
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Physiotherapy The University of Melbourne Melbourne Victoria Australia
| | - Peter J. Anderson
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Turner Institute for Brain and Mental Health & School of Psychological Sciences Monash University Melbourne Victoria Australia
| | - Lex W. Doyle
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology The University of Melbourne Melbourne Victoria Australia
| | - Jeanie L. Y. Cheong
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology The University of Melbourne Melbourne Victoria Australia
| | | |
Collapse
|
10
|
Salavati S, Bos AF, Doyle LW, Anderson PJ, Spittle AJ. Very Preterm Early Motor Repertoire and Neurodevelopmental Outcomes at 8 Years. Pediatrics 2021; 148:peds.2020-049572. [PMID: 34452979 DOI: 10.1542/peds.2020-049572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children born very preterm (<32 weeks' gestation) have more neurodevelopmental problems compared with term-born peers. Aberrant fidgety movements (FMs) are associated with adverse motor outcomes in children born very preterm. However, associations of aberrant FMs combined with additional movements and postures to give a motor optimality score-revised (MOS-R) with school-aged cognitive and motor outcomes are unclear. Our aim with this study was to determine those associations. METHODS Of 118 infants born <30 weeks' gestation recruited into a randomized controlled trial of early intervention, 97 had a general movements assessment at 3 months' corrected age and were eligible for this study. Early motor repertoire including FMs and MOS-R were scored from videos of infant's spontaneous movement at 3 months' corrected age. At 8 years' corrected age, cognitive and motor performances were evaluated. Associations of early FMs and MOS-R with outcomes at 8 years were determined using linear regression. RESULTS Seventy-eight (80%) infants with early motor repertoire data had neurodevelopmental assessments at 8 years. A higher MOS-R, and favorable components of the individual subscales of the MOS-R, including the presence of normal FMs, were associated with better performance for general cognition, attention, working memory, executive function and motor function at 8 years; eg, presence of normal FMs was associated with a 21.6 points higher general conceptual ability score (95% confidence interval: 12.8-30.5; P < .001) compared with absent FMs. CONCLUSIONS Favorable early motor repertoire of infants born <30 weeks is strongly associated with improved cognitive and motor performance at 8 years.
Collapse
Affiliation(s)
- Sahar Salavati
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Obstetrics and Gynaecology.,Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Departments of Physiotherapy.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
| |
Collapse
|
11
|
Pascoali Rodovanski G, Bêz Reus BA, Cechinel Damiani AV, Franco Mattos K, Moreira RS, Neves Dos Santos A. Home-based early stimulation program targeting visual and motor functions for preterm infants with delayed tracking: Feasibility of a Randomized Clinical Trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 116:104037. [PMID: 34293634 DOI: 10.1016/j.ridd.2021.104037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/17/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
AIMS To verify the feasibility of a home-based early stimulation program targeting visual and motor functions in preterm infants with delayed visual tracking. METHOD We applied a randomized controlled trial. We included thirty low-risk preterm infants, from both genders, with delayed visual tracking, gestational between 28-37 weeks, and age at entrance between 1-2 months of corrected age, and absence of visual impairments. Infants were divided into two groups as follows: a) standard care group (SC) that received general orientation about sensory and motor development (16 infants); b) experimental group, that received a four-week home-based early stimulation program targeting visual and motor functions (ESPVM) applied by the caregivers (14 infants). The feasibility outcomes were retention and loss rates, adherence, adverse events, and stress signals. We obtained preliminary data by comparing visual tracking, motor development, and sensory behavior between groups at the end of the intervention. RESULTS Retention rate was high, 90 % of the caregivers provided ESPVM at least 22 days, and 70 % provided SC at least 17 days. No adverse events were reported. At the end of intervention, the ESPVM group presented higher frequencies of complete visual tracking for cards 7 (ESPVM = 57.3 %, SC = 6.3 %, p = 0.006) and 8 (ESPVM = 64.3 %, SC = 12.2 %, p = 0.013), and lower scores for total sensory profile (ESPVM: median = 58, range = 46-69; SC: median = 71, range = 54-90; p = 0.016). The groups were similar for motor development. CONCLUSIONS The protocol was feasible, and the results encourage a larger randomized controlled trial.
Collapse
Affiliation(s)
| | | | | | - Karina Franco Mattos
- Department of Health Science, Federal University of Santa Catarina, Araranguá, SC, Brazil
| | - Rafaela Silva Moreira
- Department of Health Science, Federal University of Santa Catarina, Araranguá, SC, Brazil
| | | |
Collapse
|
12
|
McKelvey LM, Lewis KN, Beavers J, Casey PH, Irby C, Goudie A. Home Visiting for NICU Graduates: Impacts of Following Baby Back Home. Pediatrics 2021; 148:peds.2020-029397. [PMID: 34083358 DOI: 10.1542/peds.2020-029397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Following Baby Back Home (FBBH) home visiting program supports families of high-risk low birth weight preterm infants after discharge from a hospital NICU. This study compares the health care use, immunization, and infant mortality rate of low birth weight preterm infants enrolled in FBBH with similar infants not in the program. METHODS From January 2013 to December 2017, 498 children enrolled in FBBH were identified in Arkansas vital statistics records and the Arkansas All-Payer Claims Database. Infants in FBBH were matched with children in a control group on the basis of demographics and medical conditions of the infant. Generalized linear mixed models with double propensity-score adjustment were used to estimate program effects. RESULTS In the first year after discharge and compared with a propensity-score matched cohort of control infants, those enrolled in FBBH were significantly more likely to have higher numbers of medical appointments and more compliant immunization history. The odds of dying in the first year of life for control infants was 4.4 times (95% confidence interval: 1.2-20.7) higher than those managed in the program. CONCLUSIONS A goal of the FBBH home visiting program is to work with parents to educate and support them as they care for their medically fragile infants. We conclude that education and support was instrumental in the infant health care use and outcome differences we observed during the first year of life.
Collapse
Affiliation(s)
| | - Kanna N Lewis
- Departments of Family and Preventive Medicine.,Arkansas Center for Health Improvement, Little Rock, Arkansas
| | | | | | | | - Anthony Goudie
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Arkansas Center for Health Improvement, Little Rock, Arkansas
| |
Collapse
|
13
|
Early developmental screening and intervention for high-risk neonates - From research to clinical benefits. Semin Fetal Neonatal Med 2021; 26:101203. [PMID: 33547000 DOI: 10.1016/j.siny.2021.101203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
With advances in neonatal care there has been an increase in survival rates for infants born very preterm and/or with complex needs, such as those who require major surgery, who may not have survived decades ago. Despite advances in survival, these infants remain at high-risk for a range of neurodevelopmental delays and/or impairments including motor, cognitive and emotional/behavioural challenges. Research has improved our ability to identify which infants are at high-risk of developmental delay and/or impairments, and there is mounting evidence that early interventions can improve outcomes of these infants. However, clinical practice varies throughout the world regarding recommendations for developmental screening. Moreover, intervention, when available, is often not commenced early enough in development. Given limited resources, those infants most at risk of developmental impairments and their families should be targeted, with further research needed on the cost-effectiveness of surveillance and early interventions.
Collapse
|
14
|
Preventive Intervention Program on the Outcomes of Very Preterm Infants and Caregivers: A Multicenter Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11050575. [PMID: 33946995 PMCID: PMC8145332 DOI: 10.3390/brainsci11050575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
Increased survival in the very preterm population results in a higher risk of developing neurodevelopmental and behavioral disabilities among survivors. We examined the outcomes of very preterm infants and parents after a preventive intervention program of four home visits by a specialized nurse, 5 days, 2 weeks, and 1 month after discharge, respectively, and at CA 2 months, followed by up to 12 times of group sessions between CA 3 and 6 months. Our multicenter randomized controlled trial assessed 138 preterm infants (gestational age ≤30 weeks or birth weight ≤1500 g) enrolled from the three participating hospitals. We randomly allocated the preterm babies to either the intervention or the control group. The primary outcome was the neurodevelopmental outcomes of Bayley-III scores at CA 10 and 24 months. At CA 10 months and 24 months, there were no significant differences between the intervention and control groups in the cognitive, motor, and language domains of Bayley-III scores. In addition, there were no significant differences in the mother’s depression scale, mother–child attachment, and the modified Infant and Toddler Social and Emotional Assessment.
Collapse
|
15
|
Givrad S, Hartzell G, Scala M. Promoting infant mental health in the neonatal intensive care unit (NICU): A review of nurturing factors and interventions for NICU infant-parent relationships. Early Hum Dev 2021; 154:105281. [PMID: 33229068 DOI: 10.1016/j.earlhumdev.2020.105281] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Premature and medically vulnerable infants experience early and sometimes prolonged separation from their parents, intrusive and unnatural environments, painful and distressing procedures, difficulties with physiological regulation, increased biological and neurological vulnerabilities, and grow up to have higher rates of neurocognitive and psychosocial difficulties. Parents of infants born prematurely or with medical vulnerabilities, in turn, experience significant distress and are a psychiatrically vulnerable population, with very high rates of depression, anxiety, and posttraumatic stress disorder. The combination of these factors cause significant challenges for some of these infants and parents in developing an early optimal relationship and connection. Given the critical importance of early relationships with main caregivers for infant mental health and long-term developmental outcomes, we review various targets of intervention to promote healthy infant and parent mental health and bonding thereby facilitating an optimal infant-parent relationship in the NICU population.
Collapse
Affiliation(s)
- Soudabeh Givrad
- Weill Cornell Medicine, 525 East 68th street, box 140, New York, NY 10065, United States of America.
| | - Georgina Hartzell
- Weill Cornell Medicine, 525 East 68th street, box 140, New York, NY 10065, United States of America.
| | - Melissa Scala
- Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304, United States of America.
| |
Collapse
|
16
|
Dickinson C, Whittingham K, Sheffield J, Wotherspoon J, Boyd RN. Efficacy of interventions to improve psychological adjustment for parents of infants with or at risk of neurodevelopmental disability: A systematic review. Infant Ment Health J 2020; 41:697-722. [DOI: 10.1002/imhj.21871] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Corrine Dickinson
- Faculty of Medicine Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre The University of Queensland South Brisbane Australia
- Queensland Children's Hospital Children's Health Queensland South Brisbane Australia
| | - Koa Whittingham
- Faculty of Medicine Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre The University of Queensland South Brisbane Australia
| | - Jeanie Sheffield
- The School of Psychology The University of Queensland Brisbane Australia
| | - Jane Wotherspoon
- Faculty of Medicine Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre The University of Queensland South Brisbane Australia
| | - Roslyn N Boyd
- Faculty of Medicine Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre The University of Queensland South Brisbane Australia
- Queensland Children's Hospital Children's Health Queensland South Brisbane Australia
| |
Collapse
|
17
|
Abstract
Interventions are needed to enhance early development and minimise long-term impairments for children born very preterm (VP, <32 weeks' gestation) and their families. Given the role of the environment on the developing brain, the potential for developmental interventions that modify the infant's hospital and home environments to improve outcomes is high. Although early developmental interventions vary widely in focus, timing, and mode of delivery, evidence generally supports the effectiveness of these programs to improve specific outcomes for children born VP and their families. However, little is known about mechanisms for effectiveness, cost- and long-term effectiveness, which programs might work better for whom, and how to provide early intervention services equitably. This information is critical to facilitate systematic integration of effective developmental interventions into clinical care for infants born very preterm and their families.
Collapse
|
18
|
Buck CO, Tucker R, Vohr B, McGowan EC. Predictors of Parenting Readiness in Fathers of High-Risk Infants in the Neonatal Intensive Care Unit. J Pediatr 2020; 217:192-195.e1. [PMID: 31704051 DOI: 10.1016/j.jpeds.2019.09.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/28/2019] [Accepted: 09/27/2019] [Indexed: 11/15/2022]
Abstract
To evaluate discharge readiness perceptions among mother-father dyads, parents of infants in the neonatal intensive care unit completed a parenting readiness survey. Fathers had more favorable perceptions than their partners. Maternal perceptions and social risk, but not infant morbidities, predicted paternal perceptions. Discharge support should focus on the mother-father dyad.
Collapse
Affiliation(s)
- Catherine O Buck
- Department of Pediatrics, Yale School of Medicine, New Haven, CT.
| | - Richard Tucker
- Department of Pediatrics, Brown University/Women and Infants Hospital of Rhode Island, Providence, RI
| | - Betty Vohr
- Department of Pediatrics, Brown University/Women and Infants Hospital of Rhode Island, Providence, RI
| | - Elisabeth C McGowan
- Department of Pediatrics, Brown University/Women and Infants Hospital of Rhode Island, Providence, RI
| |
Collapse
|
19
|
Abstract
There is increasing evidence of ongoing changes occurring in short-term and long-term motor and language outcomes in former premature infants. As rates of moderate to severe cerebral palsy (CP) have decreased, there has been increased awareness of the impact of mild CP and of developmental coordination disorder on the preterm population. Language delays and disorders continue to be among the most common outcomes. In conjunction with medical morbidities, there is increased awareness of the negative impact of family psycho-socioeconomic adversities on preterm outcomes and of the importance of intervention for these adversities beginning in the neonatal ICU.
Collapse
|
20
|
Spittle AJ, Treyvaud K, Lee KJ, Anderson PJ, Doyle LW. The role of social risk in an early preventative care programme for infants born very preterm: a randomized controlled trial. Dev Med Child Neurol 2018; 60:54-62. [PMID: 29058313 DOI: 10.1111/dmcn.13594] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 12/01/2022]
Abstract
AIM To examine the differential effects of an early intervention programme for infants born preterm on neurodevelopment and parental mental health according to family social risk. METHOD One hundred and twenty infants born earlier than 30 weeks' gestation were randomized to early intervention (n=61) or control groups (n=59). Cognitive, language, and motor outcomes were assessed by blinded assessors at 2 years, 4 years, and 8 years, and primary caregivers completed questionnaires on their anxiety and depression. Outcomes at each time point were compared between groups using linear regression with an interaction term for social risk (higher/lower). RESULTS There was evidence of interactions between intervention group and social risk for cognition at 2 years and 4 years, motor function at 4 years, and language at 8 years, with a greater intervention effect in children from higher social risk environments. In contrast, the impact of early intervention on parental depressive symptoms was greater for parents of lower social risk than for those of higher social risk. INTERPRETATION Effects of early intervention on outcomes for children born preterm and their caregivers varied according to family social risk. Family social risk should be considered when implementing early intervention programmes for children born preterm and their families. WHAT THIS PAPER ADDS Intervention is associated with better early cognitive functioning for children in higher social risk families. Positive effects of intervention for the high risk group were not sustained at school-age. Intervention has a greater effect on primary caregiver mental health in the lower social risk group compared with higher social risk.
Collapse
Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Karli Treyvaud
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia.,Department of Psychology and Counselling, La Trobe University, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katherine J Lee
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| |
Collapse
|
21
|
Luu TM, Xie LF, Peckre P, Cote S, Karsenti T, Walker CD, Gosselin J. Web-Based Intervention to Teach Developmentally Supportive Care to Parents of Preterm Infants: Feasibility and Acceptability Study. JMIR Res Protoc 2017; 6:e236. [PMID: 29191797 PMCID: PMC5730819 DOI: 10.2196/resprot.8289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022] Open
Abstract
Background Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones. Objective This study aimed to test the feasibility and acceptability of the intervention by parents of preterm infants and assess clinical benefits on child neurodevelopment and parental outcomes during the first year of life. Methods A total of 107 infants born at <30 weeks and admitted to Sainte-Justine Hospital neonatal intensive care unit and their parents were enrolled in a nonrandomized controlled before-and-after interventional study (intervention n=55, comparison n=52). Acceptability of the program was assessed with a user satisfaction questionnaire. When the infants were at 4 months’ corrected age, all parents completed questionnaires on infant temperament, parenting stress, sense of competence, and parenting satisfaction. At 12 months’ corrected age, neurodevelopmental testing was performed on infants using the Alberta Infant Motor Scale and the Bayley Scales of Infant and Toddler Development, Third Edition. Comparisons between the 2 groups were done using independent t tests, Wilcoxon rank-sum tests, and Fisher exact tests. Results The majority of parents (43/45) were satisfied with the intervention program and all would recommend MAQ to others. MAQ met their need for evidence-based information that proved useful to support their child development. No difference in parental or child neurodevelopmental outcomes was detected in this pilot study for most outcomes except for higher median scores for parental coercive behaviors in the intervention group, although proportions scoring in the coercive range did not differ. Conclusions Acceptability of the program was high among parents thus supporting the relevance of such intervention. A larger study using a randomized controlled trial design is needed to better document impact on parent and children and investigate how Web-based technologies can efficiently complement individualized intervention to alleviate the burden on health care resources.
Collapse
Affiliation(s)
- Thuy Mai Luu
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Li Feng Xie
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Perrine Peckre
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Sylvana Cote
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - Thierry Karsenti
- Faculty of Teaching and Education Sciences, University of Montreal, Montreal, QC, Canada
| | - Claire-Dominique Walker
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Julie Gosselin
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada
| |
Collapse
|
22
|
Kurjak A, Antsaklis P, Stanojevic M, Vladareanu R, Vladareanu S, Neto RM, Barisic LS, Porovic S, Delic T. Multicentric studies of the fetal neurobehavior by KANET test. J Perinat Med 2017; 45:717-727. [PMID: 28493821 DOI: 10.1515/jpm-2016-0409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/30/2017] [Indexed: 11/15/2022]
Abstract
Assessment of fetal neurobehavior and detection of neurological impairment prenatally has been a great challenge in perinatal medicine. The evolution of four-dimensional (4D) ultrasound not only enabled a better visualization of fetal anatomy but also allowed the study of fetal behavior in real time. Kurjak Antenatal Neurodevelopmental Test (KANET) was developed for the assessment of fetal neurobehavior and the detection of neurological disorders, based on the assessment of the fetus by application of 4D ultrasound in the same way that a neonate is assessed postnatally. KANET is a method that has been applied for the past 10 years and studies show that it is a strong diagnostic tool and can be introduced into everyday clinical practice. We present all data from studies performed up to now on KANET.
Collapse
|
23
|
Casey PH, Irby C, Withers S, Dorsey S, Li J, Rettiganti M. Home Visiting and the Health of Preterm Infants. Clin Pediatr (Phila) 2017; 56:828-837. [PMID: 28720035 DOI: 10.1177/0009922817715949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The results of home visiting programs which target medically fragile low-birth-weight preterm infants (LBWPT) have been inconsistent. We provided nurse/social worker home visits to families of LBWPT infants on a regular schedule. Teams were trained in approaches to improve the health and development of the infants. The completion of immunization series was sigmificantly higher and the infant mortality rates of the home visits childen were significanly lower compared to national and state rates. We used state Medicaid data and examined frequency of hospitalization, emergency department visits, routine and nonscheduled visits to primary care physician, and pharmacy use of the home-visited subjects compared with a propensity-matched group. The home-visited group had more routine and nonscheduled visits but no more hospitalizations or E.D. visits. Home visiting teams improved important markers of child health, including completed immunizations and mortality rate, perhaps by the careful monitoring of health status and assuring health care when needed.
Collapse
Affiliation(s)
- Patrick H Casey
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Carmen Irby
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sandra Withers
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan Dorsey
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jingyun Li
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Malik Rettiganti
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.,2 Arkansas Children's Research Institute, Little Rock, AR, USA
| |
Collapse
|
24
|
Becker-Grünig T, Schneider S, Sonntag D, Jarczok MN, Philippi H, De Bock F. [Parental Social Status and other determinants of quality of life and behavioral problems: An analysis of German preterm births between 1987-2004]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:166-80. [PMID: 26637387 DOI: 10.1007/s00103-015-2276-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Knowledge of the factors affecting the development of preterm children in Germany is limited. We analysed the prevalence of preterm birth in Germany using the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 and assessed factors associated with quality of life (QOL) and behavioural development in preterm children (< 37 weeks' gestational age). METHODS Data were weighted and preterm prevalence was calculated by socioeconomic status (SES) and year of birth for 1,106 preterm children. Using linear regression models, the relationship between sociodemographic, pre- and perinatal, lifestyle, and contextual determinants on the one hand, and the QOL (KINDL® parent questionnaire) and behavioural problems (the total problem behaviour scale, the Strengths and Difficulties Questionnaire [SDQ]) on the other was calculated. RESULTS Prevalence of preterm birth (mean 7.5 %) was higher in families with low compared with high SES (8.4 versus 7.0 %). In the final regression models, preterm children with high SES had higher QOL scores (+ 3.3 KINDL points, p = 0.024) compared with children with low SES, and adolescents (aged 14-17 years) had a higher QOL than children aged 7-13 years. All other variables (contextual, pre- and perinatal) were not related to QOL. In contrast, there were many determinants of behavioural development in preterms: the SDQ total score was lower in girls, children with older mothers, those from high SES and those with a high level of physical activity. However, both very low birth weight (< 1,500 g) and birth at > 34 weeks' gestation were associated with a higher SDQ total score. CONCLUSION Given its high prevalence, preterm birth is a relevant public health issue in Germany. While SES may be the most important determinant of QOL in preterms, determinants of behavioural problems are the same as those in term children and also encompass perinatal factors.
Collapse
Affiliation(s)
- Tabea Becker-Grünig
- Klinik für Kinder- und Jugendmedizin, Universitätsklinik Mannheim, Mannheim, Deutschland
- Mannheimer Institut für Public Health, Sozial-, und Präventivmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Rudolph-Krehl-Straße 7-11, 68167, Mannheim, Deutschland
| | - Sven Schneider
- Mannheimer Institut für Public Health, Sozial-, und Präventivmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Rudolph-Krehl-Straße 7-11, 68167, Mannheim, Deutschland
| | - Diana Sonntag
- Mannheimer Institut für Public Health, Sozial-, und Präventivmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Rudolph-Krehl-Straße 7-11, 68167, Mannheim, Deutschland
| | - Marc N Jarczok
- Mannheimer Institut für Public Health, Sozial-, und Präventivmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Rudolph-Krehl-Straße 7-11, 68167, Mannheim, Deutschland
| | - Heike Philippi
- Sozialpädiatrisches Zentrum Frankfurt Mitte, Frankfurt am Main, Deutschland
| | - Freia De Bock
- Mannheimer Institut für Public Health, Sozial-, und Präventivmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Rudolph-Krehl-Straße 7-11, 68167, Mannheim, Deutschland.
- Sozialpädiatrisches Zentrum Frankfurt Mitte, Frankfurt am Main, Deutschland.
| |
Collapse
|
25
|
Spittle A, Treyvaud K. The role of early developmental intervention to influence neurobehavioral outcomes of children born preterm. Semin Perinatol 2016; 40:542-548. [PMID: 27817913 DOI: 10.1053/j.semperi.2016.09.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Children who are born preterm are at risk of adverse long-term neurobehavioral outcomes, including cognitive, motor, and behavioral impairments. Early developmental interventions that commence within the first year after preterm birth have a preventative focus, with the aim to positively influence the developmental trajectory. While there is a great deal of heterogeneity in the research trials to date, there is evidence that early developmental interventions have a moderate effect on cognitive and behavioral outcomes up to preschool age, with some evidence for improved motor outcomes. This review discusses key components of early developmental interventions including commencing the intervention as early as possible, ideally in the neonatal intensive care unit, and promoting developmental skills overtime with an appropriate enriched environment. The importance of involving and supporting parents in early intervention is also highlighted, particularly given the influence of the parent-infant relationship on developmental outcomes and higher rates of mental health problems in parents after preterm birth.
Collapse
Affiliation(s)
- Alicia Spittle
- Department of Physiotherapy, University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry St, Parkville 3010, Victoria, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.
| | - Karli Treyvaud
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia; Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
26
|
Effects of an intervention program on maternal and paternal parenting stress after preterm birth: A randomized trial. Early Hum Dev 2016; 103:17-25. [PMID: 27449367 DOI: 10.1016/j.earlhumdev.2016.05.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/22/2016] [Accepted: 05/03/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Preterm birth causes parenting stress and increases the risk of developmental disorders in children. Our objective was to assess the impact of an early psychological intervention, Triadic parent-infant Relationship Therapy (TRT), on parenting stress, parental mental health and preterm infant development in the motor, language, social, behavioral and emotional domains at a corrected age of 18months. METHODS Sixty-five families of preterm infants were randomly assigned to the intervention group (n=33) or the control group (n=32). Families of full-term children (n=24) were also recruited. Intervention focused on the triadic relationship and aimed to improve parenting stress by supporting parental mental health to promote infant development. The main outcome was assessed with the Parenting Stress Index Short Form (PSI-SF). RESULTS Highly significant differences at 18months were observed for the mother and father in overall PSI-SF scores, with 16.6, and 11.7 points, respectively, in favor of the intervention group. Children in the intervention group demonstrated higher full-scale developmental quotients than the preterm controls (an 8.7-point difference) along with lower scores on behavioral tests (a 5.8-point difference at 18months). At 18months, results for children in the intervention group showed no significant differences compared to the full-term group or were even better. CONCLUSIONS Our study provides sound evidence for the efficiency of the TRT program to reduce parenting stress and improve parental mental health for both parents, thus fostering the infant's overall development.
Collapse
|
27
|
McCormick MC, Litt JS. Strengthening Early Intervention for Very Preterm Infants. Pediatrics 2016; 138:peds.2016-2207. [PMID: 27940712 DOI: 10.1542/peds.2016-2207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Marie C McCormick
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts; .,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jonathan S Litt
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
28
|
Spittle AJ, Barton S, Treyvaud K, Molloy CS, Doyle LW, Anderson PJ. School-Age Outcomes of Early Intervention for Preterm Infants and Their Parents: A Randomized Trial. Pediatrics 2016; 138:peds.2016-1363. [PMID: 27940686 DOI: 10.1542/peds.2016-1363] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the child and parental outcomes at school age of a randomized controlled trial of a home-based early preventative care program for infants born very preterm and their caregivers. METHODS At term-equivalent age, 120 infants born at a gestational age of <30 weeks were randomly allocated to intervention (n = 61) or standard care (n = 59) groups. The intervention included 9 home visits over the first year of life focusing on infant development, parental mental health, and the parent-infant relationship. At 8 years' corrected age, children's cognitive, behavioral, and motor functioning and parental mental health were assessed. Analysis was by intention to treat. RESULTS One hundred children, including 13 sets of twins, attended follow-up (85% follow-up of survivors). Children in the intervention group were less likely to have mathematics difficulties (odds ratio, 0.42; 95% confidence interval [CI], 0.18 to 0.98; P = .045) than children in the standard care group, but there was no evidence of an effect on other developmental outcomes. Parents in the intervention group reported fewer symptoms of depression (mean difference, -2.7; 95% CI, -4.0 to -1.4; P < .001) and had reduced odds for mild to severe depression (odds ratio, 0.14; 95% CI, 0.03 to 0.68; P = .0152) than parents in the standard care group. CONCLUSIONS An early preventive care program for very preterm infants and their parents had minimal long-term effects on child neurodevelopmental outcomes at the 8-year follow-up, whereas primary caregivers in the intervention group reported less depression.
Collapse
Affiliation(s)
- Alicia J Spittle
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; .,Departments of Physiotherapy.,Women's Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia; and
| | - Sarah Barton
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Women's Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia; and.,Paediatrics, and.,Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia
| | - Carly S Molloy
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lex W Doyle
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Women's Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia; and.,Paediatrics, and.,Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Anderson
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Paediatrics, and
| |
Collapse
|
29
|
Yap MBH, Morgan AJ, Cairns K, Jorm AF, Hetrick SE, Merry S. Parents in prevention: A meta-analysis of randomized controlled trials of parenting interventions to prevent internalizing problems in children from birth to age 18. Clin Psychol Rev 2016; 50:138-158. [PMID: 27969003 DOI: 10.1016/j.cpr.2016.10.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/03/2016] [Accepted: 10/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE OF THE RESEARCH Burgeoning evidence that modifiable parental factors can influence children's and adolescents' risk for depression and anxiety indicates that parents can play a crucial role in prevention of these disorders in their children. However, it remains unclear whether preventive interventions that are directed primarily at the parent (i.e. where the parent receives more than half of the intervention) are effective in reducing child internalizing (including both depression and anxiety) problems in the longer term. PRINCIPAL RESULTS Compared to a range of comparison conditions, parenting interventions reduced child internalizing problems, at a minimum of 6months after the intervention was delivered. Mean effects were very small for measures of internalizing and depressive symptoms, and small for measures of anxiety symptoms. Pooled effects for anxiety diagnoses were significant and indicated a number needed to treat (NNT) of 10. Pooled effects for depression diagnoses approached significance but suggested a NNT of 11. These results were based on effects reported at the longest follow-up interval for each included study, which ranged from 6months up to 15years for internalizing measures, 5.5years for depressive measures, and 11years for anxiety measures. MAJOR CONCLUSIONS Our findings underscore the likely benefits of increasing parental involvement in preventing internalizing problems, particularly anxiety problems, in young people.
Collapse
Affiliation(s)
- Marie B H Yap
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Amy J Morgan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kathryn Cairns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Centre of Excellence in Youth Mental Health, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sally Merry
- School of Medicine, University of Auckland, New Zealand
| |
Collapse
|
30
|
Hughes AJ, Redsell SA, Glazebrook C. Motor Development Interventions for Preterm Infants: A Systematic Review and Meta-analysis. Pediatrics 2016; 138:peds.2016-0147. [PMID: 27638931 DOI: 10.1542/peds.2016-0147] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXTS Preterm infants are at an increased risk of neurodevelopmental delay. Some studies report positive intervention effects on motor outcomes, but it is currently unclear which motor activities are most effective in the short and longer term. OBJECTIVE The aim of the study was to identify interventions that improve the motor development of preterm infants. DATA SOURCES An a priori protocol was agreed upon. Seventeen electronic databases from 1980 to April 2015 and gray literature sources were searched. STUDY SELECTION Three reviewers screened the articles. DATA EXTRACTION The outcome of interest was motor skills assessment scores. All data collection and risk of bias assessments were agreed upon by the 3 reviewers. RESULTS Forty-two publications, which reported results from 36 trials (25 randomized controlled trials and 11 nonrandomized studies) with a total of 3484 infants, met the inclusion criteria. A meta-analysis was conducted by using standardized mean differences on 21 studies, with positive effects found at 3 months (mean 1.37; confidence interval 0.48-2.27), 6 months (0.34; 0.11-0.57), 12 months (0.73; 0.20-1.26), and 24 months (0.28; 0.07-0.49). At 3 months, there was a large and significant effect size for motor-specific interventions (2.00; 0.28-3.72) but not generic interventions (0.33; -0.03 to -0.69). Studies were not excluded on the basis of quality; therefore, heterogeneity was significant and the random-effects model was used. LIMITATIONS Incomplete or inconsistent reporting of outcome measures limited the data available for meta-analysis beyond 24 months. CONCLUSIONS A positive intervention effect on motor skills appears to be present up to 24 months' corrected age. There is some evidence at 3 months that interventions with specific motor components are most effective.
Collapse
Affiliation(s)
- Anita J Hughes
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; and
| | - Sarah A Redsell
- School of Nursing and Midwifery, Anglia Ruskin University, Cambridge, United Kingdom
| | - Cris Glazebrook
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; and
| |
Collapse
|
31
|
Flierman M, Koldewijn K, Meijssen D, van Wassenaer-Leemhuis A, Aarnoudse-Moens C, van Schie P, Jeukens-Visser M. Feasibility of a Preventive Parenting Intervention for Very Preterm Children at 18 Months Corrected Age: A Randomized Pilot Trial. J Pediatr 2016; 176:79-85.e1. [PMID: 27402332 DOI: 10.1016/j.jpeds.2016.05.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/06/2016] [Accepted: 05/20/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility and potential efficacy of an age-appropriate additional parenting intervention for very preterm born toddlers. STUDY DESIGN In a randomized controlled pilot study, 60 of 94 eligible very preterm born children who had received a responsive parenting intervention in their first year were randomized to usual care or the additional intervention, consisting of 4-6 home visits between 18 and 22 months' corrected gestational age (CA). Parents were supported to responsively interact during increasingly complex daily activities and play. Parental satisfaction with the intervention was evaluated with a questionnaire. At baseline and 24 months CA, parents completed the Infant Toddler Social and Emotional Assessment, the Ages and Stages Questionnaire, and the Dutch Schlichting Lexilist for receptive language. At 24 months CA, motor, and cognitive development was measured by the Bayley Scales of Infant and Toddler Development, Third Edition Dutch version, and parent-child interaction was evaluated by the Emotional Availability Scales. RESULTS Parental compliance and satisfaction with the intervention was high. Effect sizes (after correction for baseline variables) were small for internalizing and competence behavior, receptive language, and problem solving; medium for cognitive development and parent-child interaction; and large for externalizing and dysregulation behavior and motor development. CONCLUSION After a postdischarge intervention during the first year, an additional responsive parenting support at toddler-age is feasible and associated with positive outcomes in a broad array of parental and child outcome measures. TRIAL REGISTRATION www.toetsingonline.nl: NL40208.018.12.
Collapse
Affiliation(s)
- Monique Flierman
- Department of Rehabilitation, Academic Medical Center, Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
| | - Karen Koldewijn
- Department of Rehabilitation, Academic Medical Center, Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Dominique Meijssen
- Department of Rehabilitation, Academic Medical Center, Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Aleid van Wassenaer-Leemhuis
- Department of Neonatology, Academic Medical Center, Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelieke Aarnoudse-Moens
- Department of Neonatology, Academic Medical Center, Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Petra van Schie
- Department of Rehabilitation, Academic Medical Center, Amsterdam, University of Amsterdam, Amsterdam, The Netherlands; VU Medical Center, Amsterdam, The Netherlands
| | - Martine Jeukens-Visser
- Department of Rehabilitation, Academic Medical Center, Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
32
|
van Wassenaer-Leemhuis AG, Jeukens-Visser M, van Hus JWP, Meijssen D, Wolf MJ, Kok JH, Nollet F, Koldewijn K. Rethinking preventive post-discharge intervention programmes for very preterm infants and their parents. Dev Med Child Neurol 2016; 58 Suppl 4:67-73. [PMID: 27027610 DOI: 10.1111/dmcn.13049] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 12/23/2022]
Abstract
Post-discharge preventive intervention programmes with involvement of the parent may support the resilience and developmental outcomes of infants born very preterm. Randomized controlled trials of home-based family-centred intervention programmes in very preterm infants that aimed to improve cognitive outcome, at least at age two, were selected and updated on the basis of a recent systematic review to compare their content and effect over time to form the basis of a narrative review. Six programmes were included in this narrative review. Four of the six programmes led to improved child cognitive and/or motor development. Two programmes, which focused primarily on responsive parenting and development, demonstrated improved cognitive outcome up till 5 years after completion of the programme. The programmes that also focused on maternal anxiety remediation led to improved maternal mental well-being, along with improved child behaviour, in one study - even at 3 years after completion of the programme. The magnitude of the effects was modest. Family-centred preventive intervention programmes that aim at improvement of child development should be continued after discharge home to improve the preterm child's resilience. Programmes may be most effective when they support the evolvement of a responsive parent-infant relationship over time, as well as the parent's well-being.
Collapse
Affiliation(s)
| | - Martine Jeukens-Visser
- Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Janeline W P van Hus
- Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Dominique Meijssen
- Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Marie-Jeanne Wolf
- Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Joke H Kok
- Department of Neonatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Frans Nollet
- Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Karen Koldewijn
- Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
33
|
Wu YC, Hsieh WS, Hsu CH, Chang JH, Chou HC, Hsu HC, Chiu NC, Lee WT, Chen WJ, Ho YW, Jeng SF. Intervention effects on emotion regulation in preterm infants with very low birth weight: A randomize controlled trial. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 48:1-12. [PMID: 26524725 DOI: 10.1016/j.ridd.2015.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
Preterm infants are at risk for emotional difficulties and behavioral problems. This study was aimed to investigate the effects of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with a usual care program (UCP) on emotion regulation to stress in preterm infants with very low birth weight (VLBW, birth weight <1500 g). A total of 178 VLBW preterm infants had been previously randomly assigned to receive one of three interventions (57 in CBIP, 63 in HBIP and 58 in UCP). The CBIP and HBIP contained identical child-, parent- and dyad-focused interventions that were provided to infants during hospitalization and were respectively delivered at clinics and at home at PMA 36-38 and 40 weeks, and 1, 2, 4, 6, 9, 12 months of corrected age. All infants were prospectively observed for behavioral reactivity and regulation in response to experimentally evoke stress evoked by a toy-behind-barrier procedure at 12, 18, and 24 months of corrected age. Their cognitive and language abilities, and mothers' responsiveness were also assessed at 12 months as potential covariates. Compared to the UCP-group infants, the HBIP-group infants exhibited shorter durations of visual orientation to a toy (adjusted difference [95% CI]=-1.60 [-3.07 to -0.13], p=0.03), and the CBIP-group infants exhibited shorter durations of avoidance (adjusted difference [95% CI]=-0.84 [-1.57 to -0.10], p=0.03) from 12 to 24 months of corrected age. The CBIP and HBIP showed no difference in the stress reactivity from the UCP, however. These results suggest that comprehensive interventions incorporating child-, parent- and dyad-focused services enhanced VLBW preterm infants' emotion regulation in response to stress at toddler age.
Collapse
Affiliation(s)
- Ying-Chin Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Chin Hsu
- Department of Child and Family Development, University of Georgia, GA, USA
| | - Nan-Chang Chiu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-J Chen
- Graduate Institute of Epidemiology, National Taiwan University, Taipei, Taiwan
| | - Yu-Wen Ho
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
34
|
Anderson SE, McNamara K, Andridge R, Keim SA. Executive function and mealtime behavior among preschool-aged children born very preterm. Eat Behav 2015; 19:110-4. [PMID: 26276709 DOI: 10.1016/j.eatbeh.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/26/2015] [Accepted: 07/29/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether executive function in preschool-aged children born very preterm was associated with problematic mealtime behavior. STUDY DESIGN Executive function of 41 preschool-aged children (mean age=47 months) born at <30 weeks' gestation was assessed using a standardized protocol (gift bag) and by parent-report (Behavior Rating Inventory of Executive Function-Preschool). The gift bag assessment was video-recorded and good executive function defined as the child not touching the gift bag and remaining seated for >2 min. Parent-reported frequency and severity of child mealtime behavior problems was assessed with a 20-item index (Meals in Our Household, α=0.94). Multivariable regression was used to model associations between executive function and mealtime behavior problems. RESULTS BRIEF-P global executive composite t-scores [mean (standard deviation [SD])=53.5 (15.7)] and mealtime behavior problems scores [mean (SD) =18.5 (13.6)] were correlated (r=0.57, P<0.0001). Adjusted for child sex, age, birth weight, weeks' gestation, parent education, and neonatal intensive care unit length of stay, a 10-unit difference in BRIEF-P t-score was associated with a 7.2-unit difference in mealtime behavior problems score (P<0.0001). Ten children (24%) demonstrated good executive function during the gift bag assessment. Parents reported these children displayed better executive function on the BRIEF-P and had fewer mealtime behavior problems (mean 11.2 vs. 20.8, P=0.02). Adjusted for covariates, good performance on the gift bag task was associated with 14.1 unit lower mealtime behavior problems score (P=0.03). CONCLUSION Among preschool-aged children born very preterm, difficulties with executive function may manifest as mealtime behavior problems. Larger studies are needed to help parents anticipate and manage these behaviors.
Collapse
Affiliation(s)
- Sarah E Anderson
- Division of Epidemiology, The Ohio State University College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA.
| | - Kelly McNamara
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Rebecca Andridge
- Division of Biostatistics, The Ohio State University College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA
| | - Sarah A Keim
- Division of Epidemiology, The Ohio State University College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA; Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
| |
Collapse
|
35
|
Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2015; 2015:CD005495. [PMID: 26597166 PMCID: PMC8612699 DOI: 10.1002/14651858.cd005495.pub4] [Citation(s) in RCA: 236] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Infants born preterm are at increased risk of developing cognitive and motor impairment compared with infants born at term. Early developmental interventions have been provided in the clinical setting with the aim of improving overall functional outcomes for these infants. Long-term benefits of these programmes remain unclear. OBJECTIVES Primary objective To compare the effectiveness of early developmental intervention programmes provided post hospital discharge to prevent motor or cognitive impairment in preterm (< 37 weeks) infants versus standard medical follow-up of preterm infants at infancy (zero to < three years), preschool age (three to < five years), school age (five to < 18 years) and adulthood (≥ 18 years). Secondary objectives To perform subgroup analyses to determine the following.• Effects of gestational age, birth weight and brain injury (periventricular leukomalacia (PVL)/intraventricular haemorrhage (IVH)) on cognitive and motor outcomes when early intervention is compared with standard follow-up. ∘ Gestational age: < 28 weeks, 28 to < 32 weeks, 32 to < 37 weeks. ∘ Birth weight: < 1000 grams, 1000 to < 1500 grams, 1500 to < 2500 grams. ∘ Brain injury: absence or presence of grade III or grade IV IVH or cystic PVL (or both) or an abnormal ultrasound/magnetic resonance image (MRI) before initiation of the intervention.• Effects of interventions started during inpatient stay with a post-discharge component versus standard follow-up care.• Effects of interventions focused on the parent-infant relationship, infant development or both compared with standard follow-up care.To perform sensitivity analysis to identify the following.• Effects on motor and cognitive impairment when early developmental interventions are provided within high-quality randomised trials with low risk of bias for sequence generation, allocation concealment, blinding of outcome measures and selective reporting bias. SEARCH METHODS The search strategy of the Cochrane Neonatal Review Group was used to identify randomised and quasi-randomised controlled trials of early developmental interventions provided post hospital discharge. Two review authors independently searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Advanced, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE (1966 to August 2015). SELECTION CRITERIA Studies included had to be randomised or quasi-randomised controlled trials of early developmental intervention programmes that began within the first 12 months of life for infants born before 37 weeks' gestational age. Interventions could commence on an inpatient basis but had to include a post-discharge component for inclusion in this review. Outcome measures were not prespecified, other than that they had to assess cognitive outcomes, motor outcomes or both. Rates of cerebral palsy were documented. DATA COLLECTION AND ANALYSIS Two independent review authors extracted and entered data. Cognitive and motor outcomes were pooled by four age groups: infancy (zero to < three years), preschool age (three to < five years), school age (five to < 18 years) and adulthood (≥ 18 years). Meta-analysis using RevMan 5.1 was carried out to determine the effects of early developmental interventions at each age range. Subgroup analyses focused on gestational age, birth weight, brain injury, commencement of the intervention, focus of the intervention and study quality. MAIN RESULTS Twenty-five studies met the inclusion criteria (3615 randomly assigned participants). Only 12 of these studies were randomised controlled trials with appropriate allocation concealment. Variability was evident with regard to focus and intensity of the intervention, participant characteristics and length of follow-up. Meta-analysis led to the conclusion that intervention improved cognitive outcomes at infancy (developmental quotient (DQ): standardised mean difference (SMD) 0.32 standard deviations (SDs), 95% confidence interval (CI) 0.16 to 0.47; P value < 0.001; 16 studies; 2372 participants) and at preschool age (intelligence quotient (IQ); SMD 0.43 SDs, 95% CI 0.32 to 0.54; P value < 0.001; eight studies; 1436 participants). However, this effect was not sustained at school age (IQ: SMD 0.18 SDs, 95% CI -0.08 to 0.43; P value = 0.17; five studies; 1372 participants). Heterogeneity between studies for cognitive outcomes at infancy and at school age was significant. With regards to motor outcomes, meta-analysis of 12 studies showed a significant effect in favour of early developmental interventions at infancy only; however, this effect was small (motor scale DQ: SMD 0.10 SDs, 95% CI 0.01 to 0.19; P value = 0.03; 12 studies; 1895 participants). No effect was noted on the rate of cerebral palsy among survivors (risk ratio (RR) 0.82, 95% CI 0.52 to 1.27; seven studies; 985 participants). Little evidence showed a positive effect on motor outcomes in the long term, but only five included studies reported outcomes at preschool age (n = 3) or at school age (n = 2). AUTHORS' CONCLUSIONS Early intervention programmes for preterm infants have a positive influence on cognitive and motor outcomes during infancy, with cognitive benefits persisting into preschool age. A great deal of heterogeneity between studies was due to the variety of early developmental intervention programmes tested and to gestational ages of included preterm infants; thus, comparisons of intervention programmes were limited. Further research is needed to determine which early developmental interventions are most effective in improving cognitive and motor outcomes, and to discern the longer-term effects of these programmes.
Collapse
Affiliation(s)
- Alicia Spittle
- Murdoch Childrens Research Institute and the University of MelbourneVIBeS Office, 5th FloorFlemington RoadParkvilleMelbourneAustralia3052
| | - Jane Orton
- Royal Women's Hospital2nd Floor, Flemington RoadParkvilleMelbourneAustralia3052
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Royal Children’s HospitalDepartment of Clinical SciencesFlemington RoadMelbourneVictoriaAustralia3052
| | - Roslyn Boyd
- University of QueenslandBrisbaneQueenslandAustralia
| | - Lex W Doyle
- The University of MelbourneDepartment of Obstetrics and GynaecologyParkvilleVictoriaAustralia3052
| | | |
Collapse
|
36
|
Spittle AJ, Lee KJ, Spencer-Smith M, Lorefice LE, Anderson PJ, Doyle LW. Accuracy of Two Motor Assessments during the First Year of Life in Preterm Infants for Predicting Motor Outcome at Preschool Age. PLoS One 2015; 10:e0125854. [PMID: 25970619 PMCID: PMC4430525 DOI: 10.1371/journal.pone.0125854] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/26/2015] [Indexed: 11/19/2022] Open
Abstract
Aim The primary aim of this study was to investigate the accuracy of the Alberta Infant Motor Scale (AIMS) and Neuro-Sensory Motor Developmental Assessment (NSMDA) over the first year of life for predicting motor impairment at 4 years in preterm children. The secondary aims were to assess the predictive value of serial assessments over the first year and when using a combination of these two assessment tools in follow-up. Method Children born <30 weeks’ gestation were prospectively recruited and assessed at 4, 8 and 12 months’ corrected age using the AIMS and NSMDA. At 4 years’ corrected age children were assessed for cerebral palsy (CP) and motor impairment using the Movement Assessment Battery for Children 2nd-edition (MABC-2). We calculated accuracy of the AIMS and NSMDA for predicting CP and MABC-2 scores ≤15th (at-risk of motor difficulty) and ≤5th centile (significant motor difficulty) for each test (AIMS and NSMDA) at 4, 8 and 12 months, for delay on one, two or all three of the time points over the first year, and finally for delay on both tests at each time point. Results Accuracy for predicting motor impairment was good for each test at each age, although false positives were common. Motor impairment on the MABC-2 (scores ≤5th and ≤15th) was most accurately predicted by the AIMS at 4 months, whereas CP was most accurately predicted by the NSMDA at 12 months. In regards to serial assessments, the likelihood ratio for motor impairment increased with the number of delayed assessments. When combining both the NSMDA and AIMS the best accuracy was achieved at 4 months, although results were similar at 8 and 12 months. Interpretation Motor development during the first year of life in preterm infants assessed with the AIMS and NSMDA is predictive of later motor impairment at preschool age. However, false positives are common and therefore it is beneficial to follow-up children at high risk of motor impairment at more than one time point, or to use a combination of assessment tools. Trial Registration ACTR.org.au ACTRN12606000252516
Collapse
Affiliation(s)
- Alicia J. Spittle
- Murdoch Childrens Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Royal Women’s Hospital, Melbourne, Australia
- * E-mail:
| | - Katherine J. Lee
- Murdoch Childrens Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Megan Spencer-Smith
- Murdoch Childrens Research Institute, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Lucy E. Lorefice
- Murdoch Childrens Research Institute, Melbourne, Australia
- Royal Children’s Hospital, Melbourne, Australia
| | - Peter J. Anderson
- Murdoch Childrens Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Lex W. Doyle
- Murdoch Childrens Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Royal Women’s Hospital, Melbourne, Australia
| |
Collapse
|
37
|
Spencer-Smith MM, Spittle AJ, Lee KJ, Doyle LW, Anderson PJ. Bayley-III Cognitive and Language Scales in Preterm Children. Pediatrics 2015; 135:e1258-65. [PMID: 25896835 DOI: 10.1542/peds.2014-3039] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study aimed to assess the sensitivity and specificity of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), Cognitive and Language scales at 24 months for predicting cognitive impairments in preterm children at 4 years. METHODS Children born <30 weeks' gestation completed the Bayley-III at 24 months and the Differential Ability Scale, Second Edition (DAS-II), at 4 years to assess cognitive functioning. Test norms and local term-born reference data were used to classify delay on the Bayley-III Cognitive and Language scales. Impairment on the DAS-II Global Conceptual Ability, Verbal, and Nonverbal Reasoning indices was classified relative to test norms. Scores < -1 SD relative to the mean were classified as mild/moderate delay or impairment, and scores < -2 SDs were classified as moderate delay or impairment. RESULTS A total of 105 children completed the Bayley-III and DAS-II. The sensitivity of mild/moderate cognitive delay on the Bayley-III for predicting impairment on DAS-II indices ranged from 29.4% to 38.5% and specificity ranged from 92.3% to 95.5%. The sensitivity of mild/moderate language delay on the Bayley-III for predicting impairment on DAS-II indices ranged from 40% to 46.7% and specificity ranged from 81.1% to 85.7%. The use of local reference data at 24 months to classify delay increased sensitivity but reduced specificity. Receiver operating curve analysis identified optimum cut-point scores for the Bayley-III that were more consistent with using local reference data than Bayley-III normative data. CONCLUSIONS In our cohort of very preterm children, delay on the Bayley-III Cognitive and Language scales was not strongly predictive of future impairments. More children destined for later cognitive impairment were identified by using cut-points based on local reference data than Bayley-III norms.
Collapse
Affiliation(s)
- Megan M Spencer-Smith
- School of Psychological Sciences, Monash University, Melbourne, Australia; Clinical Sciences,
| | - Alicia J Spittle
- Clinical Sciences, Department of Physiotherapy, Newborn Research, and
| | - Katherine J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics
| | - Lex W Doyle
- Clinical Sciences, Research Office, The Royal Women's Hospital, Melbourne, Australia Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | | |
Collapse
|
38
|
Herskind A, Greisen G, Nielsen JB. Early identification and intervention in cerebral palsy. Dev Med Child Neurol 2015; 57:29-36. [PMID: 25041565 DOI: 10.1111/dmcn.12531] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2014] [Indexed: 12/31/2022]
Abstract
Infants with possible cerebral palsy (CP) are commonly assumed to benefit from early diagnosis and early intervention, but substantial evidence for this is lacking. There is no consensus in the literature on a definition of 'early', but this review focuses on interventions initiated within the first 6 months after term age. We cover basic neuroscience, arguing for a beneficial effect of early intervention, and discuss why clinical research to support this convincingly is lacking. We argue that infants offered early intervention in future clinical studies must be identified carefully, and that the intervention should be focused on infants showing early signs of CP to determine an effect of treatment. Such signs may be efficiently detected by a combination of neuroimaging and the General Movements Assessment. We propose a research agenda directed at large-scale identification of infants showing early signs of CP and testing of high-intensity, early interventions.
Collapse
Affiliation(s)
- Anna Herskind
- Department of Neuroscience and Pharmacology and Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Helene Elsass Center, Charlottenlund, Denmark; Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | |
Collapse
|
39
|
Abstract
ABSTRACT
Many investigations led to the conclusion that fetal behavioral patterns directly reflect developmental and maturational processes of fetal central nervous system (CNS), and may make possible to distinguish between normal and abnormal brain development as well as prenatal diagnosis of neurological impairment. The arrival of three- and four-dimensional ultrasound (3D/4D US) made possible to study fetal behavioral patterns. Kurjak's antenatal neurodevelopmental test (KANET) is the first prenatal test based on 3D/4D ultrasound examination of the fetus, that could be used for the evaluation and prediction of fetal neurological status. Here, we present our review of literature on KANET around the world and summarized results of this promising prenatal neurological screening test.
How to cite this article
Neto RM, Kurjak A. Recent Results of the Clinical Application of Kanet Test. Donald School J Ultrasound Obstet Gynecol 2015;9(4):420-425.
Collapse
|
40
|
Abstract
PURPOSE To examine the effect of shared book reading on the cognitive development of children born preterm and to determine what factors influence shared book reading in this population. DESIGN Secondary analysis using the Early Childhood Longitudinal Study-Birth Cohort, a large, nationally representative survey of children born in the United States in 2001. SAMPLE One thousand four hundred singleton preterm infants (22-36 weeks gestation). MAIN OUTCOME VARIABLE Cognitive development measured using the Bayley Mental Scale score from the Bayley Scales of Infant Development Research Edition. RESULTS Adjusting for neonatal, maternal, and socioeconomic characteristics, reading aloud more than two times a week is associated with higher cognitive development scores in two-year-old children born preterm (p < .001). Race/ethnicity and maternal education affect how often parents read to their children. Shared book reading holds potential as an early developmental intervention for this population.
Collapse
|
41
|
Lahti M, Eriksson JG, Heinonen K, Kajantie E, Lahti J, Wahlbeck K, Tuovinen S, Pesonen AK, Mikkonen M, Osmond C, Räikkönen K. Maternal Grand Multiparity and the Risk of Severe Mental Disorders in Adult Offspring. PLoS One 2014; 9:e114679. [PMID: 25493431 PMCID: PMC4262418 DOI: 10.1371/journal.pone.0114679] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/12/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Previous studies have shown that maternal grand multiparity may predict an increased risk of mental disorders in young adult offspring, but whether such effects persist throughout adulthood remains unknown. The current study examined if maternal grand multiparity predicts the risks of severe mental disorders, suicides, suicide attempts and dementias throughout adult life. METHODS Our study sample comprised 13243 Helsinki Birth Cohort Study 1934-1944 participants (6905 men and 6338 women). According to hospital birth records, 341 offspring were born to grand multiparous mothers. From Finnish national hospital discharge and causes of death registers, we identified 1682 participants diagnosed with mental disorders during 1969-2010. RESULTS Maternal grand multiparity predicted significantly increased risks of mood disorders (Hazard Ratio = 1.64, p = 0.03), non-psychotic mood disorders (Hazard Ratio = 2.02, p = 0.002), and suicide attempts (Hazard Ratio = 3.94, p = 0.01) in adult offspring. Furthermore, women born to grand multiparous mothers had significantly increased risks of any severe mental disorder (Hazard Ratio = 1.79, p = 0.01), non-psychotic substance use disorders (Hazard Ratio = 2.77, p = 0.02) schizophrenia, schizotypal and delusional disorders (Hazard Ratio = 2.40, p = 0.02), mood disorders (Hazard Ratio = 2.40, p = 0.002), non-psychotic mood disorders (Hazard Ratio = 2.91, p<0.001), and suicide attempts (Hazard Ratio = 5.05, p = 0.01) in adulthood. The effects of maternal grand multiparity on offspring psychopathology risk were independent of maternal age and body mass index at childbirth, and of year of birth, sex, childhood socioeconomic position, and birth weight of the offspring. In contrast, no significant effects were found among men. CONCLUSIONS Women born to grand multiparous mothers are at an increased risk of severe mental disorders and suicide attempts across adulthood. Our findings may inform the development of preventive interventions for mental disorders.
Collapse
Affiliation(s)
- Marius Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Johan G. Eriksson
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
- Vaasa Central Hospital, Vaasa, Finland
- Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Kati Heinonen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland
- Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jari Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Kristian Wahlbeck
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland
- The Finnish Association for Mental Health, Helsinki, Finland
| | - Soile Tuovinen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | | | - Maiju Mikkonen
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Katri Räikkönen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| |
Collapse
|
42
|
Herd M, Whittingham K, Sanders M, Colditz P, Boyd RN. Efficacy of preventative parenting interventions for parents of preterm infants on later child behavior: a systematic review and meta-analysis. Infant Ment Health J 2014; 35:630-41. [PMID: 25798512 DOI: 10.1002/imhj.21480] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this systematic review was to determine the efficacy of parenting interventions for parents of preterm infants to improve child behavior. Randomized controlled trials (RCTs) of parenting interventions for parents of preterm infants were included. Searchers were conducted of PubMed from 1951 to April 2013, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1982 to April 2013, Scopus from 1966 to April 2013, PsycINFO from 1840 to April 2013, the Web of Science, and the Cochrane Library. Twelve RCTs were identified that assessed child behavior. Of these studies, only data from three were able to be pooled for meta-analysis: the Infant Health and Development Program (IHDP) at 3 years, the Mother-Infant Transaction Program (modified; MITP-M) at 5 years, and the Victorian Infant Brain Studies (VIBeS Plus) at 4 years. Outcome from this analysis revealed a small, but significant, effect on child behavior favoring the intervention (95% CI: 0.08-0.32; p = .001). There is evidence that preterm parenting interventions can improve child behavior. Streamlined interventions such as MITP-M and VIBeS Plus that have a strong focus on the mother-infant relationship may have greatest potential.
Collapse
|
43
|
Wu YC, Leng CH, Hsieh WS, Hsu CH, Chen WJ, Gau SSF, Chiu NC, Yang MC, Hsu HC, Yu YT, Wu YT, Chen LC, Jeng SF. A randomized controlled trial of clinic-based and home-based interventions in comparison with usual care for preterm infants: effects and mediators. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2384-2393. [PMID: 24973546 DOI: 10.1016/j.ridd.2014.06.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 06/03/2023]
Abstract
This study examined the effects and mediators of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with usual care in very-low-birth-weight (VLBW) preterm infants on developmental and behavioral outcomes at 24 months of age (corrected for prematurity). In this randomized controlled trial, VLBW preterm infants received either CBIP (n=57), HBIP (n=63), or usual care (n=58) from hospitalization to 12 months. At 12 months, infant emotional regulation was assessed using the toy-behind-barrier procedure and dyadic interaction was observed during free play. At 24 months, infant developmental and behavioral outcomes were assessed using the Bayley Scales of Infant and Toddler Development- 3rd edition and the Child Behavior Checklist for Ages 1.5-5, respectively. Compared with infants under usual care, the CBIP-group infants showed higher cognitive composite scores (difference, 95% confidence interval (CI)=4.4, 0.8-7.9) and a lower rate of motor delay (odds ratio (OR), 95% CI=0.29, 0.08-0.99); the HBIP-group infants had lower sleep problem scores (difference, 95% CI=-1.4, -2.5 to -0.3) and a lower rate of internalizing problems at 24 months (OR, 95% CI=0.51, 0.28-0.93) (all p<.05). The CBIP's effect on cognitive outcome was attenuated when maternal or dyadic interactive behavior was considered; whereas the HBIP's effect on sleep and internalizing behavior was attenuated when duration of orientation to a toy or object was considered. In conclusions, interventions enhanced the cognitive, motor, and behavioral outcomes of VLBW preterm infants. The effects on cognitive and behavioral outcomes might be mediated by early-improved mother-infant interaction and infant emotional regulation, respectively.
Collapse
Affiliation(s)
- Ying-Chin Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Hon Leng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wei J Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ming-Chin Yang
- Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hui-Chin Hsu
- Department of Child and Family Development, University of Georgia, GA, USA
| | - Yen-Ting Yu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Tzu Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Chiou Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
44
|
Sassá AH, Gaíva MAM, Higarashi IH, Marcon SS. Nursing actions in homecare to extremely low birth weight infant. ACTA PAUL ENFERM 2014. [DOI: 10.1590/1982-0194201400080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To describe nursing actions implemented in a home context for the needs presented by the families of extremely low birth weight newborns. Methods This convergent care research was carried out with nine families who were visited in their home. For data collection we used semi-structured informal interviews and observation of participants during the first six months after hospital discharge. Data were analyzed using the thematic modality. Results Care needs of families during daily home care were related mainly to doubts and insecurities specific to extremely low birth weight premature babies and the care and guidance required for follow-up of newborns in general. Conclusion Nursing actions in a home context involve child evaluation, guidance, demonstrations, clarifications, referrals, and stimulation for puericulture follow-up with specialists. These actions also include facilitating family empowerment and gradual autonomy of care.
Collapse
|
45
|
Wilken M, Bartmann P. Posttraumatic feeding disorder in low birth weight young children: a nested case-control study of a home-based intervention program. J Pediatr Nurs 2014; 29:466-73. [PMID: 24796517 DOI: 10.1016/j.pedn.2014.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/02/2014] [Accepted: 04/07/2014] [Indexed: 12/12/2022]
Abstract
Low birth weight infants (LBW) are reported to be at risk for posttraumatic feeding disorder (PTFD). In this study, we evaluated the outcome of an intervention program for infants with PTFD. LBW infants with PTFD (N=21) completed feeding behavior questionnaires at entry and after completing the program and were compared to a matched control group. PTFD group infants showed a significantly high rate of food disorder symptoms at entry but not at follow-up compared to the control group. The intervention program for PTFD infants resulted in reduced feeding disorder symptoms.
Collapse
Affiliation(s)
- Markus Wilken
- Institute for Pediatric Feeding Tube Management and Weaning, Siegburg, Germany.
| | - Peter Bartmann
- Department of Neonatology, University of Bonn, Bonn, Germany
| |
Collapse
|
46
|
Treyvaud K. Parent and family outcomes following very preterm or very low birth weight birth: a review. Semin Fetal Neonatal Med 2014; 19:131-5. [PMID: 24252709 DOI: 10.1016/j.siny.2013.10.008] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Parents and the family environment have a pronounced influence on child development. For children at increased risk such as those born very preterm (VPT) or with very low birth weight (VLBW), parent and family functioning can influence the child's level of risk or resilience. This review describes parent and family outcomes after VPT/VLBW birth, specifically parental mental health, parenting stress and the impact of the child on the family. Factors associated with these outcomes are examined, as well as the specific outcomes for fathers. Overall the influence of VPT/VLBW birth on parents and the family appears to be more pronounced in early childhood, with less influence seen by the time of adolescence. Emerging evidence suggests that fathers experience high rates of psychological distress in the first months after VPT birth. Whereas characteristics of the VPT/VLBW child are strongly associated with parent and family outcomes, parent and social factors are also important influences.
Collapse
Affiliation(s)
- Karli Treyvaud
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
47
|
Treyvaud K, Lee KJ, Doyle LW, Anderson PJ. Very preterm birth influences parental mental health and family outcomes seven years after birth. J Pediatr 2014; 164:515-21. [PMID: 24359937 PMCID: PMC3950307 DOI: 10.1016/j.jpeds.2013.11.001] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 10/18/2013] [Accepted: 11/04/2013] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the long-term influence of very preterm birth on parental mental health, family functioning, and parenting stress at age 2 and 7 years. STUDY DESIGN Participants were 183 children born very preterm (<30 weeks gestation; n = 148 families) and 69 term-born children (n = 66 families). When children were age 7 years, parents were assessed based on the Hospital Anxiety and Depression Scale, the Family Assessment Device, the Parenting Stress Index, and the Social Support Questionnaire. Similar measures were evaluated at age 2 years. RESULTS When the children were age 7 years, parents of the very preterm-born children were more likely to report moderate to severe anxiety symptoms (P = .03), higher levels of depression symptoms (P = .03), poorer family functioning (P < .05), and higher levels of parenting stress (P < .001) compared with parents of the children born at term. Group differences in parenting stress and family functioning persisted after adjustment for social risk and child neurodevelopmental disability. There was strong evidence of a relationship between family functioning and parent-related stress at age 2 and 7 years (P < .001), but little evidence that parental mental health problems at 2 years were predictive of anxiety (P = .15) or depression (P = .28) at 7 years for parents of very preterm children. CONCLUSION These findings demonstrate that very preterm birth has a negative influence on parent and family functioning at 7 years after birth, which for some families is consistent with their functioning at 2 years. These results have implications for the support required by parents of very preterm children.
Collapse
Affiliation(s)
- Karli Treyvaud
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
| | - Katherine J Lee
- Murdoch Childrens Research Institute, Victoria, Australia,University of Melbourne, Victoria, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Victoria, Australia,University of Melbourne, Victoria, Australia,Royal Women's Hospital, Victoria, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Victoria, Australia,University of Melbourne, Victoria, Australia
| |
Collapse
|
48
|
Sensory profiles obtained from parental reports correlate with independent assessments of development in very preterm children at 2 years of age. Early Hum Dev 2013; 89:1075-80. [PMID: 23978398 DOI: 10.1016/j.earlhumdev.2013.07.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/19/2013] [Accepted: 07/24/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Very preterm (VPT) children have different sensory profiles than term-born controls, but how the sensory profiles in VPT children relate to development has not been reported. AIM The aim of this study was to examine the relationship between VPT infant sensory profiles and concurrent developmental outcomes at 2 years' corrected age. STUDY DESIGN Cohort study. SUBJECTS 243 children <30 weeks' gestation. OUTCOME MEASURES Primary caregivers completed the Infant/Toddler Sensory Profile Questionnaire to obtain information on sensory processing at 2 years of age. Independent observers assessed the child's neurodevelopment with either the Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development version 2 (Bayley 2) or the Cognition, Language and Motor Composites of the Bayley Scales of Infant and Toddler Development version 3 (Bayley 3). RESULTS A stronger Low Registration pattern correlated with lower MDI and PDI scores and a stronger Sensation Avoiding pattern correlated with a lower PDI score. A stronger Low Registration pattern correlated with a lower Language Composite score. More frequent visual and oral sensory processing behaviours were associated with higher performance on the MDI and PDI, with more frequent auditory sensory processing behaviours also associated with higher PDI scores. More frequent auditory, touch and oral sensory processing behaviours were associated with improved outcomes on the Language Composite and more frequent auditory, touch and vestibular processing behaviours correlated with improved outcomes on the Cognition Composite. A secondary analysis using a computed MDI score derived from the Bayley 3 scores did not substantially alter any conclusions. CONCLUSION(S) Different sensory profile patterns obtained from parental reports of VPT children are associated with various aspects of neurodevelopment at 2 years of age, obtained from independent assessment.
Collapse
|
49
|
Spittle AJ, Spencer-Smith MM, Cheong JLY, Eeles AL, Lee KJ, Anderson PJ, Doyle LW. General movements in very preterm children and neurodevelopment at 2 and 4 years. Pediatrics 2013; 132:e452-8. [PMID: 23878041 DOI: 10.1542/peds.2013-0177] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Although ~50% of very preterm (VP) children have neurodevelopmental impairments, early prediction of infants who will experience problems later in life remains a challenge. This study evaluated the predictive value of general movements (GM; spontaneous and endogenous movements) at 1 and 3 months' corrected age for neurodevelopment at 2 and 4 years of age in VP children. METHODS At 1 and 3 months' corrected age, infants born <30 weeks' gestation had GM assessed as normal or abnormal. Motor, cognitive, and language development at 2 years was assessed by using the Bayley Scales of Infant and Toddler Development, Third Edition. At 4 years, cognitive and language outcomes were assessed by using the Differential Ability Scale-Second Edition and motor outcomes with the Movement Assessment Battery for Children-Second Edition; a diagnosis of cerebral palsy was documented. RESULTS Ninety-nine VP infants were recruited, with 97% and 88% of survivors followed up at age 2 and 4 years, respectively. Abnormal GM at 1 month were associated with worse motor outcomes at 2 and 4 years but not language or cognitive outcomes. Abnormal GM at 3 months were associated with worse motor, cognitive, and language outcomes at both 2 and 4 years. Overall, GM at 1 month demonstrated better sensitivity to impairments at 2 and 4 years, whereas GM at 3 months had better specificity and were more accurate overall at distinguishing between children with and without impairment. CONCLUSIONS Abnormal GM in VP infants, particularly at 3 months postterm, are predictive of worse neurodevelopment at ages 2 and 4 years.
Collapse
Affiliation(s)
- Alicia J Spittle
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, Melbourne, Australia.
| | | | | | | | | | | | | |
Collapse
|
50
|
Spittle AJ, Spencer-Smith MM, Eeles AL, Lee KJ, Lorefice LE, Anderson PJ, Doyle LW. Does the Bayley-III Motor Scale at 2 years predict motor outcome at 4 years in very preterm children? Dev Med Child Neurol 2013; 55:448-52. [PMID: 23216518 DOI: 10.1111/dmcn.12049] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2012] [Indexed: 11/29/2022]
Abstract
AIM To assess the predictive validity of the Bayley Scales of Infant and Toddler Development - Third Edition (Bayley-III) for later motor outcome. METHOD Ninety-six infants (49 males, 47 females) born at less than 30 weeks' gestation admitted to two tertiary hospitals in Melbourne, Australia, were assessed with the Bayley-III Motor Scale at 2 years' corrected age and were classified as suspect or definite motor impairment if they scored less than -1 or -2 standard deviations respectively, relative to the test mean. At 4 years' corrected age, children completed Movement Assessment Battery for Children - Second Edition (MABC-2); for the total motor score, cut-offs of not more than the 15th were used to classify motor development and cut-offs of not more than the 15th centile were classified as having a significant movement difficulty. RESULTS Of the 96 children assessed at both ages, at 2 years 9% had suspect and 4% had definite motor impairment; however, by 4 years, rates had increased to 22% and 19% respectively. The specificity of the Bayley-III for motor impairments for later motor outcome was excellent (ranging from 94 to 100% for cerebral palsy [CP] and 97 to 100% for motor impairment), although the sensitivity was low (ranging from 67 to 83% for CP and 18 to 37% for motor impairment); many children with later impairment were not identified by the Bayley-III. INTERPRETATION The Bayley-III Motor Scale at 2 years underestimates later rates of motor impairment, particularly in the absence of CP at 4 years on the MABC-2 total motor score in children born at less than 30 weeks' gestational age.
Collapse
Affiliation(s)
- Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Australia.
| | | | | | | | | | | | | |
Collapse
|