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      Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants

      Author(s): 1 , 2 , 3 , 4 , 5
      Editor(s): Cochrane Neonatal Group
      Publication date (Electronic):
      Journal: Cochrane Database of Systematic Reviews
      Publisher: Wiley

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          Abstract

          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.

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          Most cited references145

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          Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994.

          B. Vohr, L Wright, A Dusick … (2000)
          The purposes of this study were to report the neurodevelopmental, neurosensory, and functional outcomes of 1151 extremely low birth weight (401-1000 g) survivors cared for in the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network, and to identify medical, social, and environmental factors associated with these outcomes. A multicenter cohort study in which surviving extremely low birth weight infants born in 1993 and 1994 underwent neurodevelopmental, neurosensory, and functional assessment at 18 to 22 months' corrected age. Data regarding pregnancy and neonatal outcome were collected prospectively. Socioeconomic status and a detailed interim medical history were obtained at the time of the assessment. Logistic regression models were used to identify maternal and neonatal risk factors for poor neurodevelopmental outcome. Of the 1480 infants alive at 18 months of age, 1151 (78%) were evaluated. Study characteristics included a mean birth weight of 796 +/- 135 g, mean gestation (best obstetric dates) 26 +/- 2 weeks, and 47% male. Birth weight distributions of infants included 15 infants at 401 to 500 g; 94 at 501 to 600 g; 208 at 601 to 700 g; 237 at 701 to 800 g; 290 at 801 to 900 g; and 307 at 901 to 1000 g. Twenty-five percent of the children had an abnormal neurologic examination, 37% had a Bayley II Mental Developmental Index <70, 29% had a Psychomotor Developmental Index <70, 9% had vision impairment, and 11% had hearing impairment. Neurologic, developmental, neurosensory, and functional morbidities increased with decreasing birth weight. Factors significantly associated with increased neurodevelopmental morbidity included chronic lung disease, grades 3 to 4 intraventricular hemorrhage/periventricular leukomalacia, steroids for chronic lung disease, necrotizing enterocolitis, and male gender. Factors significantly associated with decreased morbidity included increased birth weight, female gender, higher maternal education, and white race. ELBW infants are at significant risk of neurologic abnormalities, developmental delays, and functional delays at 18 to 22 months' corrected age.
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            A systematic review of the effects of early intervention on motor development.

            Ybel Blauw, Mijna Hadders-Algra (2005)
            We present a systematic review on the effect of early intervention, starting between birth and a corrected age of 18 months, on motor development in infants at high risk for, or with, developmental motor disorders. Thirty-four studies fulfilled the selection criteria. Seventeen studies were performed within the neonatal intensive care unit (NICU) environment. Eight studies had a high methodological quality. They evaluated various forms of intervention. Results indicated that the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) intervention might have a temporary positive effect on motor development. Twelve of the 17 post-NICU studies had a high methodological quality. They addressed the effect of neurodevelopmental treatment (NDT) and specific or general developmental programmes. The results showed that intervention in accordance with the principles of NDT does not have a beneficial effect on motor development. They also indicated that specific or general developmental programmes can have a positive effect on motor outcome. We concluded that the type of intervention that might be beneficial for infants at preterm age differs from the type that is effective in infants who have reached at least term age. Preterm infants seem to benefit most from intervention that aims at mimicking the intrauterine environment, such as NIDCAP intervention. After term age, intervention by means of specific or general developmental programmes has a positive effect on motor development.
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              Prevalence of motor-skill impairment in preterm children who do not develop cerebral palsy: a systematic review.

              Peter Anderson, Brian J. Lee, Jacqueline Williams (2010)
              Motor skill impairment is a common negative outcome in children born preterm who do not develop cerebral palsy (CP). This study aimed to conduct a systematic review of current data to provide an accurate estimate of the prevalence of non-CP motor impairment in preterm children at school age. We searched the Medline, PubMed, and PsycInfo databases and relevant journals to identify all studies published post-1990 that reported the prevalence of motor impairment in school-aged children born preterm (<37 wks' gestation) using standardised motor assessment batteries. We applied a range of exclusionary criteria, with 11 studies included in the final analyses. We identified two levels of motor impairment commonly reported - mild-moderate and moderate - and conducted a random effects meta-analysis to produce a prevalence estimate for each. The pooled estimate for mild-moderate impairment in preterm children was 40.5/100. and for moderate motor impairment the estimate was 19.0/100. There was also a trend for lower motor impairment levels in samples born before 1990 compared with those born after 1990. Children born preterm are at increased risk of motor impairment, with prevalence three to four times greater than in the general population. This highlights the need for improved surveillance and intervention strategies in this group of children.
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                Author and article information

                Journal
                Journal ID (publisher-id): 146518
                Title: Cochrane Database of Systematic Reviews
                Publisher: Wiley
                ISSN (Electronic): 14651858
                Publication date (Electronic): November 24 2015
                Affiliations
                [1 ]Murdoch Childrens Research Institute and the University of Melbourne; VIBeS Office, 5th Floor Flemington Road Parkville Melbourne Australia 3052
                [2 ]Royal Women's Hospital; 2nd Floor, Flemington Road Parkville Melbourne Australia 3052
                [3 ]Murdoch Childrens Research Institute, Royal Children’s Hospital; Department of Clinical Sciences; Flemington Road Melbourne Victoria Australia 3052
                [4 ]University of Queensland; Brisbane Queensland Australia
                [5 ]The University of Melbourne; Department of Obstetrics and Gynaecology; Parkville Victoria Australia 3052
                Article
                DOI: 10.1002/14651858.CD005495.pub4
                PubMed ID: 26597166
                SO-VID: cdb4c1cf-4df5-447a-87d5-efc4045c80e7
                Copyright © © 2015
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